Form Ia 1139-Cap - Application For Refund Due To The Carryback Of Capital Losses
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1
2Iowa Department of Revenue
IA 1139-CAP
Reset Form
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Application for Refund
Due to the Carryback of Capital Losses
Do not attach to Iowa return; mail in separate envelope.
Corporation Name and Address:
FEIN:
Do not attach to Iowa
return; mail in separate
Type of Tax:
envelope.
Corporation
Franchise
Loss Return for the period ended ____/____/____
An Iowa capital loss
Amount of
Remaining to be
can be carried back
Capital Loss
carried forward
three tax periods.
Check box if name, address, or FEIN
$ _______________
$ ________________
has changed.
Federal Audit Involved
YES
NO
Phone No. (_____)______-____________
NOTE: The net operating loss
2nd preceding
1st preceding
3rd preceding
and alternative minimum tax loss
tax period____/____/____
tax period____/____/____
tax period____/____/____
can only be carried forward for
after carryback
as last reported
after carryback
as last reported
after carryback
as last reported
tax years beginning on or after
January 1, 2009.
on ________
on ________
on ________
1. Net Income ................................................
____________________________________________________________________________________________________________
2. Iowa Capital Loss ......................................
____________________________________________________________________________________________________________
3. Capital Loss Subtotal. Subtract line 2 from 1.
____________________________________________________________________________________________________________
4. 50% Federal Refund From Capital Loss ..
____________________________________________________________________________________________________________
5. Subtotal. Add lines 3 and 4. ......................
____________________________________________________________________________________________________________
6. Nonbusiness Income .................................
____________________________________________________________________________________________________________
7. Income Subject To Apportionment
____________________________________________________________________________________________________________
8. Iowa Percentage ........................................
____________________________________________________________________________________________________________
9. Income Apportioned To Iowa ....................
____________________________________________________________________________________________________________
10. Iowa Nonbusiness Income ........................
____________________________________________________________________________________________________________
11. Income Before Net Operating Losses
____________________________________________________________________________________________________________
12. Iowa Net Operating Loss Carryforward
____________________________________________________________________________________________________________
13. Iowa Net Operating Loss Carryback
____________________________________________________________________________________________________________
14. Income Subject To Tax ..............................
____________________________________________________________________________________________________________
15. Computed Tax ...........................................
____________________________________________________________________________________________________________
16. Alternative Minimum Tax. Attach forms. ...
____________________________________________________________________________________________________________
17. Total Tax Liability .......................................
____________________________________________________________________________________________________________
18. Recomputed Tax Liability from line 17. .....
____________________________________________________________________________________________________________
19. Decrease In Tax. Subtract line 18 from line 17.
____________________________________________________________________________________________________________
Under penalties of perjury, I declare that I have examined this return and attached schedules/statements, and, to the best of my
knowledge, believe it to be true, correct, and complete. If prepared by a person other than the taxpayer, the declaration is based
on all information of which there is any knowledge.
Officer’s Signature: _______________________________________ Date: ________
Title: __________________________________
Preparer’s Signature: _____________________________________ Date: ________
Preparer’s Phone: _______________________
You must attach a copy of page 1 of the company’s Iowa returns
Preparer’s ID No.: ______________________
as filed and any federal forms 1120X or 1139 filed for all periods
involved with this claim.
Interest on claim will accrue starting on the date all required information is received by the Department.
42-028a
(06/24/11)
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