Kim Reynolds, Governor
Adam Gregg, Lt. Governor
Rod A. Roberts, Labor Commissioner
Iowa Division of Labor | Contractor Registration
150 Des Moines Street, Des Moines, IA 50309-1836
Phone: 515-242-5871 | Fax: 515-725-2427 | www.iowacontractor.gov | contractor.registration@iwd.iowa.gov
Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request to individuals with disabilities.
For deaf and hard of hearing, use Relay 711.
IOWA
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Contractor Registration #:
Business Name:
FEE EXEMPTION FORM
Check all that apply to your current situation:
I am a self-employed contractor.
I do not pay more than $2,000.00 per year to employ other people in the business (do not include
yourself) in the business of construction.
I never perform construction work with or for other contractors working in the “same phase of
construction.” The “same phase of construction” is defined as the same type of work, such as
masonry, stonework, electrical work or concrete work, etc.
If applicable, I have enclosed a list of all current employees and a list of all employees who have
worked for me in the past 12 months and the amount paid to each employee.
If all of the statements are true, you may qualify for an exemption from the $50.00 yearly contractor registration
fee. If your business changes so that you no longer meet the fee exemption requirements, you must
immediately forward the fee to the Iowa Division of Labor. Attach an additional sheet for employee data, if
necessary. A new fee exemption form is required yearly along with renewing your contractor registration.
Please have a notary public ready to witness when signing this fee exemption form. Attach this form to your
application and forward to the Division of Labor.
To be filled out only by a notary public
Contractor’s printed name Contractor’s signature Date
STATE OF COUNTY OF
Signed and sworn to (or affirmed) before me on this day of , 20 .
By
(printed contractor’s name)
NOTARY PUBLIC in and for the State of
My commission expires
