Information 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 PO Box):
Correct mailing name and address:
Mail corrections,
cancellation or changes to:
Registration Services
PO Box 10465
Des Moines IA 50306-0465
QUARTERLY EXEMPTIONS
QUARTERLY EXEMPTIONS RETURN
Exemptions are sales made by you on which tax was
13 Interstate Commerce
not required to be charged. Enter your exemptions for
14 Govt Units/Educ Inst
the entire quarter on this return. Enter the amount
from line 21 on line 4 below.
15 Resale/Processing
16 Farm Machinery/Equip
17 Indust Mach, Equip, Comp
18 New Construction
19 Exempt Food/Drugs
20 Other:
Other:
Other:
21 Total Exemptions
If you had no sales in Iowa this quarter, put zeroes on lines 1
IOWA RETAILER'S USE TAX QUARTERLY RETURN
and 12.
32-001 rf15a (11/19/01)
1 Gross Sales in Iowa (quarter)
2 Goods Consumed in Iowa (quarter)
3 Total (add lines 1 and 2)
4 Exemptions (from line 21) (quarter)
5 Taxable Amount (line 3 minus line 4)
Permit No.
Period
Date Due
6a State Tax (5% of line 5) (quarter)
6b Total Local Option Tax (quarter)
6c Total School Local Option Tax (quarter)
7 Total Tax (add lines 6a, 6b, and 6c)
8 Deposits and Overpayment Credits
9 Balance (line 7 minus line 8)
10 Penalty (if applicable)
11 Interest (if applicable, see instructions)
Date
Title
Signature of Retailer or Agent
12 Total Amount Due (add lines 9-11)
Daytime Phone No.: ________________