Iowa First-Time Homebuyer Savings Account
Annual Report
41-164a (08/17/2020)
Primary Account Holder:
Social Security number:
Primary last name: __________________________ First name: _____________________________
Secondary Account Holder:
Social Security number:
Secondary last name: _______________________ First name: _____________________________
Designated Beneficiary Information:
Social Security number:
Beneficiary last name: _____________________ First name: ____________________________
Withdrawal or Deposit Amount Withdrawn or
Date of Deposit or
Description of Use of
Date the account was opened (MMDDYY):
Ending account balance: .00
Total deductions to date: .00
Mail form to: Iowa Department of Revenue, PO Box 1792, Des Moines, IA 50306-1792
Annual Report, page 2
41-164b (06/19/2020)
Iowa First-Time Homebuyer Account Holder and Designated Beneficiary Instructions
Primary Account Holder(s) Information:
Enter the name and SSN of the primary account
holder. The account holder is the person who
owns the bank account designated as a first-
time homebuyer savings account. The account
holder will also be the person eligible to receive
Iowa income tax deductions for contributions
made to the account during the tax year.
Secondary Account Holder: (Available only
for married couples filing a joint Iowa individual
income tax return). Enter the name and SSN of
the spouse of the primary account holder. A
secondary account holder must be the spouse
of the primary account holder, and the two
spouses must jointly own the account
designated as a first-time homebuyer savings
account. Only spouses who file joint Iowa
income tax returns may be joint first-time
homebuyer savings account holders. Married
couples who file separately or separately on a
combined return, for Iowa income tax purposes
are not eligible, and must open separate first-
time homebuyer accounts if they wish to
participate in the program.
Designated Beneficiary Information: Enter
the beneficiary’s name and SSN. Each first-time
homebuyer savings account may have only one
designated beneficiary. A designated
beneficiary must be an individual who qualifies
as a first-time homebuyer. An account holder
may also be the designated beneficiary of an
account. An eligible individual may be the
designated beneficiary of more than one
account, but no account holder may establish
more than one account for the same designated
List of Withdrawals or Deposits: Enter
whether you made a withdrawal or deposit.
Enter the amount of funds you withdrew or
deposited and the date you withdrew or
deposited these funds. Enter the description of
what the funds were used for. If you need more
space than provided, you may copy the table.
Date the Account Was Opened: Enter the date
you opened the qualifying interest-bearing
savings account you wish to designate as a first-
time homebuyer savings account.
Ending Account Balance: Enter the account
balance after the withdrawal(s). This should
match the ending account balance shown on the
supporting documentation included with this
form. Provide a copy of your ending bank
statement with the submission of your First Time
Home Buyers Account Annual Report.
Total Deductions to Date: Enter the total
amount of deduction that has been taken to
date. This amount will need to be calculated by
adding up the amount of deductions you have
taken on this year’s return and prior year’s
returns as a first-time homebuyer deduction
listed as an other adjustment. No taxpayer may
deduct more than their applicable lifetime cap,
determined by the year they first established a
first-time homebuyer savings account.
Applicable Lifetime Caps by Year:
Year account
lifetime limit
for joint
lifetime limit
for all others
Mail form to:
Iowa Department of Revenue
PO Box 1792
Des Moines, IA 50306-1792