1. Number of tickets:
(5%of tickets sold)
5. # of complimentary
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
8. Subtract line #7 from line #4: $
Add line #6 (if applicable): $
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
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.
Printed name Signature Date
Iowa Division of Labor
150 Des Moines Street
Des Moines, IA 50309-1836
Phone: 515-745-2632 | Fax: 515-281-5361
http://athletic.iowa.gov | firstname.lastname@example.org
Promoter license number for event
Address of sales tax permit holder
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