Iowa Department of Revenue
www.iowa.gov/tax
Construction Contract Claim for Refund
NAME OF governmental unit, private nonprofit educational institution, nonprofit museum, business in economic development area, rural water district, or Habitat for Humanity
1.Description of project: _________________________________________
2.Final settlement date of contract: _____________ Claim must be filed within one year of final settlement.
3. Was contract in writing? ________ If so, date signed: _________________ Contract must be in writing to be eligible
for a refund.
4.Have you previously filed a claim for this project? _______
5.Are you claiming a refund for which you received a tax credit certificate? _______ If yes, a copy of the tax credit certificate must be included with this claim for refund.
Items 1 – 5 and the local option tax summary on the reverse side must be completed before your claim can be processed.
LIST CONTRACTORS AND SUBCONTRACTORS ONLY. ATTACH ADDITIONAL SHEETS IF NEEDED.
NAME OF CONTRACTOR/ |
MATERIAL PURCHASES |
SUBCONTRACTOR |
AMOUNT |
TAX TO BE REFUNDED
Iowa Sales/Use |
Local Option |
SUBTOTALS
TOTAL REFUND DUE: Add Iowa sales/use tax and local option tax columns.
I, the undersigned, declare under penalty of perjury that I have examined this claim, including all attached contractors statements, and, to the best of my knowledge and belief, it is a true, correct, and complete claim. This claim is filed pursuant to section 423.4 Code of Iowa.
Signature: ________________________________________________ Print Name: _______________________________________
Title: __________________________________ Daytime Telephone Number: ______________________ Date: _______________
SUBMIT COMPLETED FORM WITH ORIGINAL CONTRACTOR’S STATEMENTS TO:
TAX MANAGEMENT DIVISION
IOWA DEPARTMENT OF REVENUE
PO BOX 10465
DES MOINES IA 50306-0465
Construction Contract Claim for Refund
County |
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Number |
Local Option Sales Tax |
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01 |
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02 |
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03 |
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04 |
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05 |
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06 |
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07 |
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08 |
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09 |
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10 |
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11 |
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12 |
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13 |
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14 |
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15 |
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16 |
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17 |
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18 |
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19 |
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20 |
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21 |
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22 |
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23 |
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24 |
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25 |
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26 |
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27 |
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28 |
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29 |
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30 |
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31 |
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32 |
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33 |
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County |
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Number |
Local Option Sales Tax |
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
County |
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Number |
Local Option Sales Tax |
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67 |
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68 |
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69 |
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70 |
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71 |
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72 |
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73 |
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74 |
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75 |
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76 |
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77 |
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78 |
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79 |
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80 |
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81 |
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82 |
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83 |
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84 |
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85 |
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86 |
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87 |
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88 |
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89 |
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90 |
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91 |
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92 |
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93 |
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94 |
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95 |
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96 |
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97 |
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98 |
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99 |
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Total Local Option Sales Tax
Instructions: |
Report the total local option sales tax as found on all the contractor’s statements attached to this claim for refund. They must be |
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broken down by county in order to process your claim. The totals should match the local option sales tax subtotal on the front side |
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of the form. This information is necessary to make appropriate distributions of the local option sales tax. Failure to provide this |
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breakdown will delay processing of your refund claim. |
IOWA COUNTIES AND COUNTY NUMBERS
01-ADAIR |
15-CASS |
29-DES MOINES |
43-HARRISON |
57-LINN |
71-O’BRIEN |
85-STORY |
02-ADAMS |
16-CEDAR |
30-DICKINSON |
44-HENRY |
58-LOUISA |
72-OSCEOLA |
86-TAMA |
03-ALLAMAKEE |
17-CERRO GORDO |
31-DUBUQUE |
45-HOWARD |
59-LUCAS |
73-PAGE |
87-TAYLOR |
04-APPANOOSE |
18-CHEROKEE |
32-EMMET |
46-HUMBOLDT |
60-LYON |
74-PALO ALTO |
88-UNION |
05-AUDUBON |
19-CHICKASAW |
33-FAYETTE |
47-IDA |
61-MADISON |
75-PLYMOUTH |
89-VAN BUREN |
06-BENTON |
20-CLARKE |
34-FLOYD |
48-IOWA |
62-MAHASKA |
76-POCAHONTAS |
90-WAPELLO |
07-BLACK HAWK |
21-CLAY |
35-FRANKLIN |
49-JACKSON |
63-MARION |
77-POLK |
91-WARREN |
08-BOONE |
22-CLAYTON |
36-FREMONT |
50-JASPER |
64-MARSHALL |
78-POTTAWATTAMIE |
92-WASHINGTON |
09-BREMER |
23-CLINTON |
37-GREENE |
51-JEFFERSON |
65-MILLS |
79-POWESHIEK |
93-WAYNE |
10-BUCHANAN |
24-CRAWFORD |
38-GRUNDY |
52-JOHNSON |
66-MITCHELL |
80-RINGGOLD |
94-WEBSTER |
11-BUENA VISTA |
25-DALLAS |
39-GUTHRIE |
53-JONES |
67-MONONA |
81-SAC |
95-WINNEBAGO |
12-BUTLER |
26-DAVIS |
40-HAMILTON |
54-KEOKUK |
68-MONROE |
82-SCOTT |
96-WINNESHIEK |
13-CALHOUN |
27-DECATUR |
41-HANCOCK |
55-KOSSUTH |
69-MONTGOMERY |
83-SHELBY |
97-WOODBURY |
14-CARROLL |
28-DELAWARE |
42-HARDIN |
56-LEE |
70-MUSCATINE |
84-SIOUX |
98-WORTH |
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99-WRIGHT |