CHAPTER 4
FORMS
[Prior to 7/13/88, see Secretary of State[750], Ch 4]
721—4.1(17A) Forms and instructions. Forms and their instructions are developed by the agency in accordance with statutory directives. Forms used on the secretary of state website’s fast track filing system have the same functions and descriptions as the forms described in this chapter.
Copies of forms relating to corporation matters, the Uniform Commercial Code, elections, and other services may be seen at the secretary of state’s Lucas State Office Building office, Des Moines, Iowa 50319; or on the secretary of state website at sos.iowa.gov.
The subrules which follow describe those forms which members of the public use when dealing with the agency and its various divisions.
	4.1(1) Forms of general application.
	a. 	Public disclosure of gifts made to a “local official,” “local employee,” or to the person’s immediate family.
	b. 	Disaster Recovery Registration—used for registering in compliance with Iowa Code chapter 29C.
	c. 	Apostille or Certification Request Form—used to order apostilles or certified copies.
	d. 	Condemnation Application—for use by county recorders and sheriffs pursuant to Iowa Code sections 6B.3(3)“b” and 6B.38(2).
	e. 	Credit Card Payment Authorization Form—used to pay fees with a credit or debit card.
	f. 	Charge Transaction Form—used to charge fees to an existing secretary of state charge account.
	g. 	Transient Merchant Application—application for transient merchant license required by Iowa Code section 9C.3.
	h. 	Application for Registration/Renewal as an Athlete Agent—used to apply for a new certificate of registration to act as an athlete agent in the state of Iowa or to renew an existing registration.
	4.1(2) Notary public forms. Copies of notary public forms are available to the public on the secretary of state website at sos.iowa.gov or upon request to the Notary Clerk, Office of the Secretary of State, Lucas State Office Building, Des Moines, Iowa 50319. The telephone number is (515)281-5204.
	a. 	Application for Commission as Notary Public—used to apply to be commissioned as an Iowa notary public.
	b. 	Application for Renewal of Commission—used to apply to renew an existing Iowa notary public commission.
	c. 	Notary Public Change/Amendment to Application—used to update an Iowa notary public commission record.
	d. 	Certificate of Notarial Commission.
	e. 	Statement of Complaint Regarding a Notary Public, Notarial Officer, or Remote Notarization Transaction.
	f. 	Application for Approval to Perform Notarial Acts for Remotely Located Individuals.
	4.1(3) Trademark registration forms.
	a. 	Trademark/Service Mark Registration Application—application to register a mark currently in use in Iowa.
	b. 	Trademark/Service Mark Renewal Application—application to apply to renew mark registration for one additional five-year period.
	c. 	Trademark Assignment Application—to assign a mark registration from current registrant to a new registrant.
	4.1(4) Credit services organization forms.
	a. 	Registration of Credit Services Organization—registration statement required by Iowa Code section 538A.5.
	b. 	Credit Services Organization Bond Form—submitted with Iowa Code section 538A.4 surety bond filing.
	c. 	Surety Account Notice for a Credit Services Organization—submitted in accordance with Iowa Code section 538A.4 to notify the secretary of state of establishment of a surety account.
This rule is intended to implement Iowa Code chapter 17A.
[ARC 7059C, IAB 8/23/23, effective 9/27/23]
721—4.2(17A) Business entity forms. Copies of business entity forms are available to the public on the secretary of state website at sos.iowa.gov or upon request to the Business Services Division, Office of the Secretary of State, Lucas State Office Building, Des Moines, Iowa 50319. The telephone number is (515)281-5204.
	4.2(1) For-profit and nonprofit business entity forms.
	a. 	Certificate of Good Standing—shows that a corporation is in good standing and is also used to reflect that certain filings have not been made.
	b. 	Certification Certificates—certifies copies attached are true reproductions of documents on file.
	c. 	Application for Certificate of Withdrawal—used by a foreign entity to stop business in Iowa.
	d. 	Profit Corporation Statement of Withdrawal—used by a foreign profit corporation to stop business in Iowa.
	e. 	Application for Certificate of Authority—used by a foreign entity to apply for authority to do business in Iowa.
	f. 	Foreign Profit Corporation Registration Statement—used by a foreign profit corporation to apply for authority to do business in Iowa.
	g. 	Certificate of Authority—issued to foreign entities that have registered to do business in Iowa.
	h. 	Application for Reinstatement—used by an administratively dissolved corporation, limited liability company, or cooperative to apply for reinstatement.
	i. 	Application for Reservation of Name—form by which applicant can reserve an entity name for future use.
	j. 	Fictitious Name Resolution—used by a registered entity to notify the office of its adoption of a fictitious name.
	k. 	Statement of Change of Registered Office and/or Registered Agent—used by a registered entity to change its registered office and/or registered agent.
	l. 	Appointment of Agent (501B)—used by an unincorporated nonprofit association to appoint its registered office and registered agent.
	m. 	Application for Amended Certificate of Authority—used by authorized foreign entities to reflect changes of name or authorized purposes.
	n. 	Amended Foreign Registration Statement—used by authorized foreign profit corporations to reflect changes of name or other information.
	o. 	Application for Registration of a Corporate Name—form by which a foreign corporation may register a name.
	p. 	Application for Renewal of Registration of Corporate Name—used to renew registration of name.
	q. 	Notice of Transfer of Reservation of Name—used to transfer an entity name reservation from one person to another.
	4.2(2) Biennial reports.
Biennial Report for an Iowa Corporation—required to be filed by all domestic for-profit corporations.
Biennial Report for a Foreign Corporation—required to be filed by all foreign for-profit corporations.
Iowa Nonprofit Biennial Report—required to be filed by all domestic nonprofit corporations.
Foreign Nonprofit Biennial Report—required to be filed by all foreign nonprofit corporations.
Iowa Professional Biennial Report—required to be submitted by domestic professional corporations.
Domestic Professional Corporation Biennial Report Statement Under Oath—required by Iowa Code section 496C.21(1)“b” to be submitted with the Iowa professional biennial report.
Foreign Professional Biennial Report—required to be filed by foreign professional corporations.
Foreign Professional Corporation Biennial Report Statement Under Oath—required by Iowa Code section 496C.21(1)“c” to be submitted with the foreign professional biennial report.
Cooperative Association Biennial Report—required to be filed by cooperative associations.
	4.2(3) Agricultural reporting.
	a. 	Biennial Agricultural Report—used by U.S. holders of Iowa agricultural land to comply with Iowa Code chapter 10B biennial reporting requirements.
	b. 	Pork and Beef Processor Report—used by Iowa pork and beef processors to comply with Iowa Code chapter 202B annual reporting requirements.
	c. 	Registration of Nonresident Alien Land Ownership—used by non-U.S. holders of Iowa agricultural land to comply with Iowa Code chapter 9I registration requirements.
	d. 	Nonresident Alien Land Ownership Report—used by non-U.S. holders of Iowa agricultural land to comply with Iowa Code chapter 9I annual reporting requirements.
Information regarding forms for agricultural reporting may be requested from the Business Services Division, Office of the Secretary of State, Lucas State Office Building, Des Moines, Iowa 50319. The telephone number is (515)281-5204.
This rule is intended to implement Iowa Code sections 9I.7, 9I.8, 9I.9, 10B.4, 202B.301, and 202B.302.
[ARC 7059C, IAB 8/23/23, effective 9/27/23]
721—4.3(17A) Election forms.
Section 1. Election Day and Canvass Forms

Form Number	Description	
1-A(Rev.-95)	Voter’s Declaration of Eligibility	
1-B	(Reserved)	
1-C	(Reserved)	
1-D(Rev.-90)	Notice to Voter of Rejection of Absentee or Special Ballot	
1-E	(Reserved)	
1-F(Rev.-90)	Oath for Officer or Clerk of Election	
1-G(Rev.-95)	Statement to Person Casting a Special Ballot	
1-H(Rev.-95)	Envelope for Special Ballot	
1-I(Rev.-95)	Affidavit of Voter Requesting Assistance	
1-J(Rev.-95)	Declaration of Intent to Serve as Election Observer (Public Measure Elections)	
1-K(Rev.-90)	Ballot Record and Receipt	
1-L(Rev.-95)	County Abstract of Votes	
1-M(93)	Accreditation Form—Pollwatchers for Political Parties (Challenging Committees)	
1-N(93)	Accreditation Form—Observers for Political Parties (To Witness the Counting of Ballots)	
1-O(95)	Letter of Appointment—Pollwatchers for Nonpartisan and Nonparty Candidates	
1-P(95)	Application for Additional Ballots	
1-Q(95)	Application for Additional Ballots—Auditor’s Record of Telephone Request	
1-R(95)	Ballot Photocopy Record	
1-S(97)	Identification Statement	
Section 2. Nomination Documents and Forms	
Form Number	Description	
2-A(Rev.-97)	Affidavit by Candidate—Primary Election	
2-B(Rev.-97)	Affidavit by Candidate—Nominations by Political Parties	
2-C(Rev.-97)	Affidavit by Candidate—Nominations by Nonparty Political Organizations	
2-D(Rev.-97)	Affidavit by Candidate—Nonpartisan Nominations	
2-E(Rev.-97)	Nomination Paper—For U.S. Senator, U.S. Representative & Statewide Offices	
2-F(Rev.-97)	Nomination Paper—For State Senator	
2-G(Rev.-97)	Nomination Paper—For State Representative	
2-H(Rev.-97)	Nomination Paper—For Nonpartisan Nominations and Nonparty Political Organizations	
2-I(Rev.-93)	Certificate of Nomination by Nonparty Political Organization—Chapter 44	
2-J(Rev.-97)	Nomination Petition for the Offices of Electors for President and Vice President of the United States	
2-K(Rev.-97)	Nomination Paper for County Office	
2-L(Rev.-95)	Nomination by Convention—Certificate of Nomination by Political Party—Chapter 43	
2-M(Rev.-97)	Affidavit by Candidate—School and City Elections	
2-N(Rev.-97)	Affidavit by Candidate—City Elections—Chapter 44	
2-O(Rev.-97)	Nomination Petition—Merged Area Schools	
2-P(Rev.-97)	Petition Requesting Election	
2-Q(93)	Judicial Declaration of Candidacy	
2-R(93)	Certificate of Candidates for Presidential Electors	
2-S(Rev.-97)	Nomination Petition—Governor and Lieutenant Governor—Chapter 45	
Section 3. Absentee Voting Forms	
Form Number	Description	
3-A(Rev.-97)	Application for Absentee Ballot	
3-B(Rev.-97)	Absent Voter’s Affidavit and Envelope	
3-C(Rev.-90)	Affidavit for Voter Who Did Not Receive Absent Voter’s Ballot	
3-D(Rev.-97)	Absentee Ballot Carrier Envelope	
3-E(93)	Statement of Voter—Lost Absentee Ballot	
3-F(93)	Log for Absentee Ballot Delivery Team	
3-G(Rev.-95)	Challenge of Absentee Voter	
3-H(Rev.-97)	Statement to Voter of Change or Declaration of Party Affiliation	
3-I(97)	Statement to Voter of Change or Declaration of Party Affiliation for
Voter in Nursing Home or Hospital	
Section 4. Armed Forces and Overseas Absentee Voting	
Form Number	Description	
4-A(Rev.-97)	Armed Forces or Overseas Ballot—Delivery Envelope	
4-B(Rev.-97)	Armed Forces or Overseas Ballot—Return Carrier Envelope	
4-C(Rev.-97)	Armed Forces or Overseas Ballot—Affidavit Envelope	
4-D(93)	Proxy Absentee Ballot Request	
Section 5. Administrative Forms	
Form Number	Description	
5-A	(Reserved)	
5-B(Rev.-97)	Certificate of Test—Central Count Tabulating Equipment	
5-C(Rev.-97)	Certificate of Test—Precinct Count Tabulating Equipment	
5-D(Rev.-95)	Election Document Retention Record	
5-E	Rescinded	
This rule is intended to implement Iowa Code sections 43.13, 43.14, 43.18, 43.42, 43.43, 43.61, 43.67, 43.88, 44.3, 45.1, 45.3, 46.20, 48A.4, 48A.32, 49.65, 49.66, 49.77, 49.79, 49.80, 49.81, 49.90, 49.91, 49.104(2), 49.104(3), 49.104(5), 49.104(6), 50.3, 50.4, 50.5, 50.9, 50.10, 50.12, 50.19, 50.24, 50.26, 50.28, 51.11, 52.23, 52.35, 52.38, 53.2, 53.13, 53.19, 53.21, 53.22, 53.23(4), 53.25, 53.26, 53.30, 53.31, 53.40, 53.46(2), 54.5, 56.2(5), 260C.15(2), 277.4, 278.2, 331.306, 362.4 and 376.4 and 11 CFR, Subpart C, Section 8.7(1995).
721—4.4(554,17A) Uniform Commercial Code forms.
UCC1—Financing Statement.
UCC1Ad—Financing Statement Addendum (used in connection with UCC1).
UCC3—Financing Statement Amendment.
UCC3Ad—Financing Statement Amendment Addendum (used in connection with UCC3).
UCC5—Information Statement.
UCC11—Information Request.
Affidavit of Wrongful Filing—used to assert that a UCC document was not authorized to be filed and was caused to be communicated to the filing office with the intent to harass or defraud the affiant.
Master File Agreement—used to order corporation and UCC data.
Security Authorization Request—used to apply for security authorization to receive corporation and UCC data.
This rule is intended to implement Iowa Code chapter 554 (Article 9).
[ARC 7059C, IAB 8/23/23, effective 9/27/23]
721—4.5(572,17A) Mechanics’ notice and lien registry (MNLR) forms.
	1.	Mechanics’ Notice and Lien Registry—used to provide submitter information in conjunction with other MNLR forms.
	2.	Cover Page for Commencement of Work Notice—used in compliance with Iowa Code section 572.13A.
	3.	Cover Page for Preliminary Notice—used in compliance with Iowa Code section 572.13B.
	4.	Cover Page for Mechanics’ Lien - Commercial—used in compliance with Iowa Code section 572.8.
	5.	Cover Page for Mechanics’ Lien - Residential—used in compliance with Iowa Code section 572.8.
	6.	Mechanics’ Lien—used to comply with Iowa Code section 572.8.
	7.	Assignment of Mechanics’ Lien—used to transfer a lien.
	8.	Cover Page for Bond for Discharge of Lien—used in compliance with Iowa Code section 572.15.
	9.	Cover Page for Bond to Prevent Exemplary Damages—used in compliance with Iowa Code section 572.30(2).
	10.	Affidavit for Release of Mechanics’ Lien Bond—used in compliance with 721—subrule 45.8(3).
	11.	Cover Page for Demand for Acknowledgment—used in compliance with Iowa Code section 572.23.
	12.	Cover Page for Demand to Commence Action—used in compliance with Iowa Code section 572.28.
	Information regarding forms for the mechanics’ notice and lien registry may be requested from the Business Services Division, Office of the Secretary of State, Lucas State Office Building, Des Moines, Iowa 50319. The telephone number is (515)281-5204.
This rule is intended to implement Iowa Code chapter 572.
[ARC 7059C, IAB 8/23/23, effective 9/27/23]
721—4.6(9A,17A) Athlete agent. Rescinded ARC 7059C, IAB 8/23/23, effective 9/27/23.
[Filed emergency 6/25/80—published 7/23/80, effective 7/l/80]
[Filed 9/24/80, Notice 8/20/80—published 10/15/80, effective 11/19/80]
[Filed 11/30/83, Notice 10/12/83—published 12/21/83, effective 1/25/84]
[Filed emergency 7/3/84—published 8/184, effective 7/3/84]
[Filed emergency 8/3/84—published 8/29/84, effective 8/3/84]
[Filed 12/14/84, Notice 8/1/84—published 1/2/85, effective 2/6/85]
[Filed emergency 7/6/87—published 7/29/87, effective 7/6/87]
[Filed emergency 8/4/87—published 8/26/87, effective 8/4/87]
[Filed 9/4/87, Notice 7/29/87—published 9/23/87, effective 10/28/87]
[Filed 6/23/88, Notice 5/18/88—published 7/13/88, effective 8/17/88]
[Filed emergency 7/8/88—published 7/27/88, effective 7/8/88]
[Filed 5/12/89, Notice 2/22/89—published 5/31/89, effective 7/19/89]
[Filed emergency 6/9/89—published 6/28/89, effective 7/1/89]
[Filed 8/16/89, Notice 5/17/89—published 9/6/89, effective 10/11/89]
[Filed 7/5/90, Notice 5/30/90—published 7/25/90, effective 8/29/90]
[Filed emergency 6/21/91—published 7/10/91, effective 7/1/91]
[Filed emergency 7/10/91—published 8/7/91, effective 7/10/91]
[Filed 8/13/93, Notice 6/23/93—published 9/1/93, effective 10/6/93]
[Filed 8/25/95, Notice 7/19/95—published 9/13/95, effective 10/18/95]
[Filed 8/22/97, Notice 7/16/97—published 9/10/97, effective 10/15/97]
[Filed 10/29/99, Notice 9/8/99—published 11/17/99, effective 12/22/99]
[Filed emergency 6/8/01—published 6/27/01, effective 7/1/01]
[Filed 12/30/05, Notice 11/23/05—published 1/18/06, effective 2/22/06]
[Filed ARC 2962C (Notice ARC 2856C, IAB 12/7/16), IAB 3/1/17, effective 4/5/17]
[Filed ARC 7059C (Notice ARC 6886C, IAB 2/8/23), IAB 8/23/23, effective 9/27/23]