Fillable Receipt Report Must Be Sent To The Iowa (Office of the Chief Information Officer)

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Receipt Report Must Be Sent To The Iowa (Office of the Chief Information Officer)

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BROWSE OFFICE OF THE CHIEF INFORMATION OFFICER (IA) FORMS

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1. Number of tickets:
Sold at: $
Total: $
Number of tickets:
Sold at: $
Total: $
Number of tickets:
Sold at: $
Total: $
Number of tickets:
Sold at: $
Total: $
Number of tickets:
Sold at: $
Total: $
2. Total #
tickets sold:
3. Allowed
(5%of tickets sold)
complimentary tickets:
4. Total gate
receipts: $
5. # of complimentary
tickets issued:
6. Total value of complimentary tickets: $
Complimentary tickets issued = 5% of the tickets sold. The value of complimentary tickets in excess of 5% of
the tickets sold shall be included in the gross admission receipts.
7. Local option Iowa Sales Tax rate for the jurisdiction of the event https://lge.iowa.gov/SalesTaxRate.html.
Divide line #4 by 1.0____. Multiply by .0____. $
Make check payable to: Iowa Department of Revenue. Mail check to: Iowa Athletic Commission
Total $
9. 5% Athletic/Admissions Tax
Divide line #8 total by 1.05 Multiply by .05: $
Make check payable to and mail to:
Iowa Athletic Commission
Athletic Events
Receipt Report
Form
I, have examined this report and state that the facts and
computations herein are accurate.
Tabulated and prepared by:
This report along with 2 checks payable to the Iowa Department of Revenue and Iowa Athletic Commission
must be sent to the Iowa Athletic Commission within 20 days after the event date.
Licensee name
Printed name Signature Date
Revised 10/23/2019
Iowa Division of Labor
Athletic Commission
150 Des Moines Street
Des Moines, IA 50309-1836
Phone: 515-745-2632 | Fax: 515-281-5361
http://athletic.iowa.gov | athletics@iwd.iowa.gov
Promoter business name
Contact name
Phone number
Email address
Event date
Event location
Address of event
City
State
Zip
Promoter license number for event
Sales tax permit number
Address of sales tax permit holder
City
State
Zip
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0.00
0.00
0.00
0.00
0
0
0.00
0.00
0.00
0.00
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Receipt Report Must Be Sent To The Iowa (Office of the Chief Information Officer)

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Completed 21 July 2020

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