Form 92-033 - Request For Change, Correction Or Cancellation Of Tax Permit
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1Request for Change, Correction or Cancellation
IOWA
department of Revenue and Finance
of Tax Permit
Return This Form To:
Or Fax It To:
Customer Accounts
515/281-3906
Registration Services
Iowa Department of Revenue and Finance
P.O. Box 10465
Des Moines, IA 50306-0465
Legal Name _________________________________________________________
Trade Name _________________________________________________________
Address ____________________________________________________________
Indicate by checkmark and permit number those permit records you request to change, correct or cancel.
Retailer’s Sales Tax Permit
No. ____________________________________
Motor Vehicle Fuel License
No. ____________________________________
Retailer’s Use Tax Permit
No. ____________________________________
Withholding Agent ID
No. ____________________________________
Consumer’s Use Tax Permit
No. ____________________________________
MVF Tax Permit(s)
No. ____________________________________
Other: __________________________ No. ____________________________________
Checkmark and complete the applicable area(s):
Cancel Reason: _________________________________ Effective date: ____________________
Reinstate: _______________________________________ Effective date: ____________________
Change business/trade name to: ______________________________________________________
Change mailing address to: __________________________________________________________
_________________________________________________________________________________
Change location address to: __________________________________________________________
_________________________________________________________________________________
Add corporate officer name: _________________________________________________________
Address: _________________________________________ Soc. Sec. No. ____________________
Delete corporate officer name: ______________________ Soc. Sec. No. ____________________
Add partner name: _________________________________________________________________
Address: _________________________________________ Soc. Sec. No. ____________________
Delete partner name: _______________________________ Soc. Sec. No. ____________________
Change of filing frequency: __________________________________________________________
Other corrections: __________________________________________________________________
You will also need to complete a new permit application form if you are changing:
• location address from one Iowa county to another and have a sales tax permit or consumer’s use tax permit
• ownership or incorporating
Owner Signature: ___________________________________________________ Date: ________________
Owner Title: ______________________________________________________
92-033 (9/99)
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