Iowa Form 44 017B – Fill Out and Use This PDF

Nonresident Claim For Release From Withholding

https://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 https://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 or Iowa alternative minimum tax. No release letter will be issued if the qualified nonresident is tax- exempt. Source income less than $1,000 is released from withholding and no letter is sent.

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 Number: ____________

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.

Signature: ___________________________________________

Date: ___________________

44-017 (07/19/19)