Small Business Relief Tax Deferral Application

https://tax.iowa.gov

To provide financial assistance to small businesses economically impacted by the COVID-19 pandemic, the Iowa Department of Revenue is allowing for deferrals of sales tax and withholding tax in certain circumstances, including providing for a suspension of penalty and interest. Beginning May 1, 2020, the Department is now accepting applications for 30-day extensions for eligible businesses for sales tax and withholding tax payments for tax periods beginning April 1, 2020 through June 30, 2020. Each completed application received will be reviewed.

Only sales tax or withholding tax permits that are in good standing with the Iowa Department of Revenue regarding filing and payment will be considered for relief.

Legal name:

Enter your 9-digit Social Security Number or Federal Employer Identification Number (FEIN): (If you have applied but not yet received an FEIN, enter all zeros)

Business Information

Doing business as:

Physical Address

City

State

Zip

Mailing address is the same as physical address

Yes

Mailing Address

City

State

Zip

Phone number

Phone extension

Primary business activity:

Beginning March 15, 2020, what is the estimated loss of revenue?

Describe the economic injury that has resulted from COVID-19:

If a request for tax deferral is granted, taxpayers are still expected to file their quarterly tax return by the original due date. However, they will be given 30 days to pay the balance due for the applicable taxes. Penalties and interest would be suspended for the first 30 days following the original due date. Penalties will be assessed and interest would begin to accrue 31 days following the original due date.

Tax deferral applied for: Check one or both.

Sales Tax

Withholding Tax

9-digit Sales Tax permit number:

Provide additional Sales Tax permit number(s), separating each entry with a semicolon.

12-digit Withholding Tax permit number

Provide additional Withholding Tax permit number(s), separating each entry with a semicolon.

Signature
I, the undersigned, declare under penalties of perjury or false certificate, that I have examined this application, and, to the best of my knowledge and belief, it is true, correct, and complete.

Signature:

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Title: