Fillable Iowa Business Tax Change (State of Iowa - OCIO)

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Iowa Business Tax Change (State of Iowa - OCIO)

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Iowa Business Tax Change
Request for Change, or Correction, or Reinstatement of Tax Permit
https://tax.iowa.gov
92-033a (06/06/19)
Complete this form to change information relating to your business’s tax permit. You may also
change a permit online at https://tax.iowa.gov.
Legal Name: _____________________________________________________________________
Doing Business As: _______________________________________________________________
Provide a social security number if the business is registered as a sole proprietor or single member
LLC. Provide a Federal Employer Identification Number for all other business types.
Social Security Number (SSN): ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Federal Employer Identification Number (FEIN): ___ ___ - ___ ___ ___ ___ ___ ___ ___
Address: ________________________________________________________________________
City: ________________________________________ State: ___ ___ ZIP: ___ ___ ___ ___ ___
Phone: ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___
Permit(s) to be changed, check all that apply:
☐ Sales Tax, Automobile Rental, Hotel/Motel Permit: ___ - ___ ___ - ___ ___ ___ ___ ___ ___
☐ Consumer’s Use Tax Permit: ___ - ___ ___ - ___ ___ ___ ___ ___ ___
☐ Retailer’s Use Tax Permit: ___ - ___ ___ - ___ ___ ___ ___ ___ ___
☐ Water Service Excise Tax Permit: ___ - ___ ___ - ___ ___ ___ ___ ___ ___
☐ Withholding Tax Permit: ___ ___ - ___ ___ ___ ___ ___ ___ ___- ___ ___ ___
☐ Fuel Tax Permit: ___ - ___ ___ - ___ ___ ___ ___ ___ ___
1. Change Legal Name
Permits are not transferrable. If ownership is changing, all existing permits must be cancelled,
and you must reapply for new permits under the newly named entity.
Reason for Change: ____________________________________________________________
Current Legal Name: ____________________________________________________________
New Legal Name: ______________________________________________________________
2. Change “Doing Business As" Name
“Doing Business As” may vary for each business location.
Reason for Change: ____________________________________________________________
Prior “Doing Business As” Name: __________________________________________________
New “Doing Business As” Name: __________________________________________________
For Office Use Only:
Iowa Business Tax Change, page 2
92-033b (06/06/19)
3. Change Partners, Corporate Officers, or Responsible Parties
Check the box to add or inactivate an individual. Provide the name, SSN, personal address, and
effective date. Include additional sheets if necessary.
Reason for Change: ____________________________________________________________
a. Add ☐ Inactivate ☐
Individual Last Name: __________________________ First Name: __________________
SSN: __ __ __ - __ __ - __ __ __ __ Phone: __ __ __ - __ __ __ - __ __ __ __
Home Address: ____________________________________________________________
City: __________________________________ State: ___ ___ ZIP: ___ ___ ___ ___ ___
Effective Date: ___ ___ / ___ ___ / ___ ___
b. Add ☐ Inactivate ☐
Individual Last Name: __________________________ First Name: __________________
SSN: __ __ __ - __ __ - __ __ __ __ Phone: __ __ __ - __ __ __ - __ __ __ __
Home Address: ____________________________________________________________
City: _________________________________ State: ___ ___ ZIP ___ ___ ___ ___ ___
Effective Date: ___ ___ / ___ ___ / ___ ___
c. Add ☐ Inactivate ☐
Individual Last Name: First Name:
SSN: __ __ __ - __ __ - __ __ __ __ Phone: __ __ __ - __ __ __ - __ __ __ __
Home Address: ____________________________________________________________
City: __________________________________ State: ___ ___ ZIP: ___ ___ ___ ___ ___
Effective Date: ___ ___ / ___ ___ / ___ ___
d. Add ☐ Inactivate ☐
Individual Last Name: __________________________ First Name: __________________
SSN: __ __ __ - __ __ - __ __ __ __ Phone: __ __ __ - __ __ __ - __ __ __ __
Home Address:
City: __________________________________ State: ___ ___ ZIP: ___ ___ ___ ___ ___
Effective Date: ___ ___ / ___ ___ / ___ ___
4. Change Business Location Address
Cancel your sales tax and/or use tax permit(s) and complete a new business tax permit
registration form if you are changing:
• Location address from one Iowa county to another
• Location address from Iowa to out of state
• Location address from out of state to Iowa
Reason for Change: ____________________________________________________________
New Location Address: __________________________________________________________
City: ______________________________________ State: ___ ___ ZIP: ___ ___ ___ ___ ___
County:
Iowa Business Tax Change, page 3
92-033c (06/06/19)
5. Change Business Mailing Address
☐Check if same as business location address in section 4.
Mailing address will be effective for all tax types listed. If you want a different mailing address for
each tax type checked on page one include a separate sheet.
New Mailing Address: ___________________________________________________________
City: ______________________________________ State: ___ ___ ZIP: ___ ___ ___ ___ ___
6. Change Filing Frequency (if qualified)
For each permit being changed, check the frequency requested and effective date. Note that
filing history must meet the filing threshold. For more information about filing frequencies, visit
https://tax.iowa.gov.
Reason for Change: ____________________________________________________________
Effective Date: ___ ___ / ___ ___ /___ ___
Check One Filing Frequency per Permit:
Sales Tax: Annually ☐ Quarterly ☐ Monthly ☐ Semimonthly ☐
• Note: Sales tax permits that have Automobile Rental, Hotel/Motel, or are consolidated may
not be filed annually.
Consumer’s Use Tax: Annually ☐ Quarterly ☐
Retailer’s Use Tax: Annually ☐ Quarterly ☐ Monthly ☐
Water Service Excise Tax: Annually ☐ Quarterly ☐ Monthly ☐ Semimonthly ☐
Withholding Tax: Quarterly ☐ Monthly ☐ Semimonthly ☐
7. Reinstate Permit. Complete this section only if you are seeking to reinstate a previously
canceled permit.
Effective Date (first date of business activity): ___ ___ / ___ ___ / ___ ___
Reason for Reinstatement: _______________________________________________________
Location Address:
City: State: ___ ___ ZIP: ___ ___ ___ ___ ___
Mailing Address: ☐Check if same as business location address above.
Mailing Address: _______________________________________________________________
City: ______________________________________ State: ___ ___ ZIP: ___ ___ ___ ___ ___
8. Signature. This application must be signed by owner, or a partner or corporate officer.
I, the undersigned, declare under penalties of perjury or false certificate, that I have examined
this form, and, to the best of my knowledge and belief, it is true, correct, and complete.
Signature: _______________________________________ Date: ___ ___ / ___ ___ / ___ ___
Print Name: ______________________________ Phone: __ __ __ - __ __ __- __ __ __ __
Contact Name: _____________________________ Contact Email: _______________________
Questions?
Contact Taxpayer Services:
Phone: 515-281-3114 or 800-367-3388
Email: idr@iowa.gov
Submit this form by:
Fax: 515-281-3906
Mail: Registration Services
Iowa Department of Revenue
PO Box 10470
Des Moines IA 50306-0470
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Iowa Business Tax Change (State of Iowa - OCIO)

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Completed 9 February 2021

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