Information Form - Iowa Sales Tax Annual Report
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1
2Information Form
Use this form to report address and name changes, cancel your permit, change
your filing frequency, or request information on Electronic Funds Transfer (EFT).
Permit number
Enter weekday phone number
Location name and address
Mailing name and address
If different than above:
If different than above:
Correct location name and address (not a PO Box):
Correct mailing name and address:
Mail corrections,
cancellation or changes to:
Registration Services
PO Box 10465
Des Moines IA 50306-0465
SALES TAX ANNUAL RETURN
IOWA
31-010 RF41A 11/19/02
ANNUAL EXEMPTIONS
ANNUAL EXEMPTIONS RETURN
Exemptions are sales made by you on which tax was
13 Interstate Commerce
not required to be charged. Enter your exemptions
14 Govt Units/Educ Inst
for the entire year on this return. Enter the amount
15 Resale/Processing
from line 21 on line 4 below.
16 Farm Machinery/Equip
17 Indust Mach, Equip, Comp
18 New Construction
19 Exempt Food/Drugs
20 Other:
Other:
Other:
21 Total Exemptions
IMPORTANT: You must file even if you had no sales tax activity during
the year.If you had no sales, put zeroes on lines 1 and 12.
s
1 Gross Sales
s
2 Goods Consumed
3 Total (add lines 1 and 2)
s
4 Exemptions (from line 21)
5 Taxable Amount (line 3 minus line 4)
s
s
Permit No.
Period
Date Due
s
6a State Sales Tax (5% of line 5)
s
6b Total Local Option Sales Tax
s
6c Total School Local Option Tax
7 Total Tax (add lines 6a, 6b, and 6c)
s
8 Deposits and Overpayment Credits
9 Balance (line 7 minus line 8)
s
10 Penalty (if applicable)
s
11 Interest (if applicable, see instructions)
Title
Signature of Retailer or Agent
Date
s
12 Total Amount Due (add lines 9-11)
Daytime Phone No.: ________________
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