Fill and Sign the Louisiana Tax Declaration Form

Iowa Department of Revenue www.iowa.gov/tax eFile & Pay Application to Become a Bulk Filer A Bulk Filer (or Service Provider) is a third party who, by agreement, files electronic tax transactions, either in bulk or single entry online, on behalf of taxpayer clients. Legal Name __________________________________________________________________ Mailing Address ______________________________________________________________ City _________________________ State _______ Zip Code _______________ Federal ID Number ___________________ Social Security Number (if sole proprietor) ________________ Contact Person _______________________________________________________________ Contact Telephone # __________________ Contact Fax # ____________________ Contact E-mail Address ___________________________ Upon receipt of this application, the department will send a letter to you specifically for bulk filers. A Business eFile Number (BEN) will also be provided by mail, unless you already have one. If you already have a BEN, a new number will not be issued. Additional information for bulk filers may be found on our Web site at www.state.ia.us/tax As a third party bulk filer, you have the option to file a client’s transaction information individually online at the eFile Internet site or submit an electronic file containing transactions for multiple clients. NOTE: One electronic payment cannot cover multiple transactions. All of your clients must be properly registered with the Iowa Department of Revenue. Any transactions filed for unregistered clients will be rejected. Name of Owner, Officer, Partner or Responsible Party ________________________________ Signature of Owner, Officer, Partner or Responsible Party _____________________________ Date ___________________ By submitting this application, the above party agrees to abide by the statutes and regulations of the State of Iowa in the filing of returns on behalf of taxpayers. This application does not grant power of attorney to the above party to act on behalf of the taxpayer regarding tax matters with the Iowa Department of Revenue or allow the above party to act as an agent of the department. Bulk filers may wish to have an Iowa Power of Attorney form on file with the department for their clients. A Power of Attorney form is available at the department’s Internet site under “Tax Forms.” Fax completed application to Business Registration at 515.281.3906 or mail to: Iowa Department of Revenue Hoover Building PO Box 10470 Des Moines, IA 50306-0470 If you have questions concerning this application, contact Taxpayer Services at 515.281.3114 or 1-800-367-3388 (Iowa only) or e-mail idr@iowa.gov 78-004 (12/21/12)