Nonresident Request for Release from Withholding 44 017 2011

Nonresident Claim For Release From Withholding tax. iowa.gov Instructions Iowa withholding must be withheld from Iowa nonwage income paid to a nonresident. However a nonresident may choose to make an Iowa estimated payment instead of having Iowa tax withheld from the nonwage income. To make an Iowa estimated payment the nonresident must file this form and an IA 1040ES voucher with payment equal to 5 of line 3 below. This form must be filed prior to receiving Iowa nonwage income. Upon receipt of this form and payment the Department will issue a release letter to the payer s of the Iowa nonwage income. The IA 1040ES voucher and instructions are available on our website at tax. iowa*gov* Mail this form the IA 1040ES voucher and payment to Compliance Services Iowa Department of Revenue PO Box 10456 Des Moines IA 50306-0456 Tax-exempt If a nonresident qualifies to be tax-exempt then the payer is released from withholding. A nonresident is tax-exempt if Line 3 below is 1 000 or less and not subject to Iowa lump-sum tax. No release letter will be issued if the qualified nonresident is tax-exempt. Questions 515-281-3114 800-367-3388 or idr iowa*gov* Nonresident Payee For fiscal/calendar year ending MM/DD/YYYY Name Social Security Number SSN Address City State ZIP Phone Income from Iowa Source s Name of Payer s Address of Payer s 1. Iowa-source estimated gross income. 1. 2. Related business expenses. 2. 3. Iowa estimated net income subtract line 2 from line 1. 3. Check this box to claim tax-exempt status. I the undersigned declare under penalties of perjury or false certificate that I have examined this document and to the best of my knowledge and belief it is true correct and complete. However a nonresident may choose to make an Iowa estimated payment instead of having Iowa tax withheld from the nonwage income. To make an Iowa estimated payment the nonresident must file this form and an IA 1040ES voucher with payment equal to 5 of line 3 below. To make an Iowa estimated payment the nonresident must file this form and an IA 1040ES voucher with payment equal to 5 of line 3 below. This form must be filed prior to receiving Iowa nonwage income. Upon receipt of this form and payment the Department will issue a release letter to the payer s of the Iowa nonwage income. This form must be filed prior to receiving Iowa nonwage income. Upon receipt of this form and payment the Department will issue a release letter to the payer s of the Iowa nonwage income. The IA 1040ES voucher and instructions are available on our website at tax. iowa*gov* Mail this form the IA 1040ES voucher and payment to Compliance Services Iowa Department of Revenue PO Box 10456 Des Moines IA 50306-0456 Tax-exempt If a nonresident qualifies to be tax-exempt then the payer is released from withholding. The IA 1040ES voucher and instructions are available on our website at tax. iowa*gov* Mail this form the IA 1040ES voucher and payment to Compliance Services Iowa Department of Revenue PO Box 10456 Des Moines IA 50306-0456 Tax-exempt If a nonresident qualifies to be tax-exempt then the payer is released from withholding. A nonresident is tax-exempt if Line 3 below is 1 000 or less and not subject to Iowa lump-sum tax. No release letter will be issued if the qualified nonresident is tax-exempt.