Form 35-002a - Iowa Contractor'S Statement (Page 2 of 2) in pdf

Instructions for Contractor’s Statement

Contractor:

This Contractor’s Statement must be prepared and sworn to by each general

contractor, special contractor, or subcontractor who fulfills a contract or

Forward this statement to the sponsor (governmental unit, private nonprofit

subcontract pertaining to a project that is sponsored by agencies or

educational institution, nonprofit museum, business in economic

instrumentalities of the federal, state, county, municipal governments,

development area, rural water district, or Habitat for Humanity).

private nonprofit educational institutions, nonprofit museums, businesses in

Do NOT send it to the Iowa Department of Revenue.

economic development areas, rural water districts, or Habitat for Humanity.

Sponsor:

Upon completion of the contract, this form must be presented to that sponsor

so they may file for a tax refund in accordance with section 423.4, Iowa

This statement must be attached to the Construction Contract Claim for

Code, as amended.

Refund (35-003). Both forms must be filed before the Department can

process your claim. File using this form. Substitutes or photocopies will not

be accepted. The claim for refund must be filed within one year of the final

settlement date of the contract.

Form Instructions

Columns A through E must be completed. If local option sales tax was

and the Iowa permit number under which it was remitted. If no Iowa tax was

paid on the purchase price, complete columns A through H.

paid, please explain why not and/or to which state the tax was paid.

A. Name, City, and State of Material Supplier

F. Amount of Iowa Local Option Tax

“Out of stock” or “inventory” should be entered in column A for materials

In addition to the state sales and use tax in column D, there may be

that the contractor has manufactured or has in inventory, making the

purchases that were subject to local option tax. Enter the amount of local

contractor the material supplier.

option tax in column F. Do not include local option tax in column D entry.

B. Type of Building Material

G. County Number

Be specific. Only the items that become an integral part of the structure

Number of the county for which local option sales tax was paid. See the list

should be listed. The following is a nonexclusive list of items that should

below.

NOT be included on this form: Equipment rental, machinery, equipment,

tools, utilities, warning lights, barricades, portable toilets, forms, stakes,

scaffolding, dynamite, lodging, fuel, and labor.

IOWA COUNTIES AND COUNTY NUMBERS

01-ADAIR

21-CLAY

41-HANCOCK

61-MADISON

81-SAC

C. Purchase Price

02-ADAMS

22-CLAYTON

42-HARDIN

62-MAHASKA

82-SCOTT

03-ALLAMAKEE

23-CLINTON

43-HARRISON

63-MARION

83-SHELBY

04-APPANOOSE

24-CRAWFORD

44-HENRY

64-MARSHALL

84-SIOUX

Cost of material shown in column B. Do NOT include transportation

05-AUDUBON

25-DALLAS

45-HOWARD

65-MILLS

85-STORY

06-BENTON

26-DAVIS

46-HUMBOLDT

66-MITCHELL

86-TAMA

charges, delivery charges, or hauling charges. Do NOT include sales/use or

07-BLACK HAWK

27-DECATUR

47-IDA

67-MONONA

87-TAYLOR

local option sales tax in this column.

08-BOONE

28-DELAWARE

48-IOWA

68-MONROE

88-UNION

09-BREMER

29-DES MOINES

49-JACKSON

69-MONTGOMERY

89-VAN BUREN

10-BUCHANAN

30-DICKINSON

50-JASPER

70-MUSCATINE

90-WAPELLO

D. Amount of Iowa Sales / Use Tax

11-BUENA VISTA

31-DUBUQUE

51-JEFFERSON

71-O’BRIEN

91-WARREN

12-BUTLER

32-EMMET

52-JOHNSON

72-OSCEOLA

92-WASHINGTON

13-CALHOUN

33-FAYETTE

53-JONES

73-PAGE

93-WAYNE

Compute on the purchase price recorded in column C. Do NOT include

14-CARROLL

34-FLOYD

54-KEOKUK

74-PALO ALTO

94-WEBSTER

15-CASS

35-FRANKLIN

55-KOSSUTH

75-PLYMOUTH

95-WINNEBAGO

local option sales tax in column D.

16-CEDAR

36-FREMONT

56-LEE

76-POCAHONTAS

96-WINNESHIEK

17-CERRO GORDO

37-GREENE

57-LINN

77-POLK

97-WOODBURY

18-CHEROKEE

38-GRUNDY

58-LOUISA

78-POTTAWATTAMIE

98-WORTH

E. Did Supplier Collect Iowa Sales / Use Tax?

19-CHICKASAW

39-GUTHRIE

59-LUCAS

79-POWESHIEK

99-WRIGHT

20-CLARKE

40-HAMILTON

60-LYON

80-RINGGOLD

If the answer is “no,” include who paid the tax, the date the tax was paid,

35-002b (07/01/13)

Form 35-002a - Iowa Contractor'S Statement Page 2

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