Form 4797n - Special Capital Gains/extraordinary Dividend Election And Computation - 2012 Page 3
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6PART II — DETERMINE IF A NON-EMPLOYEE QUALIFIES TO MAKE
FORM 4797N
2012
THE ELECTION
PART III — DETERMINE IF THE CAPITAL STOCK QUALIFIES
Parts II and III
Name on Form 1040N or Form 1041N
Social Security Number
PART II — DETERMINE IF A NON-EMPLOYEE QUALIFIES TO MAKE THE ELECTION
1 What is your relationship to the employee?
Spouse
Descendant (Oldest child or grandchild)
Other STOP . You do not qualify to make the election .
2 Is the employee still living?
STOP. Only the employee can make the election .
YES
NO
Continue .
3 Was the employee married on the date of the employee’s death AND is the spouse still living?
If you are the spouse, go to Part I to make the election . All others STOP . Only the spouse can make the election .
YES
NO
Continue .
4 Are you the oldest surviving descendant (for example, child, grandchild)?
You may go to Part I to make the election.
YES
STOP. You do not qualify to make the election .
NO
PART III — DETERMINE IF THE CAPITAL STOCK QUALIFIES
1 What is your relationship to the employee?
Spouse
Descendant
Trust
2 Was the capital stock a gift from the employee? (Note – inherited stock is not a gift and does not qualify .)
If you are the spouse, go to the next question. If you represent the trust, go to Question 4. If you are a descendant,
YES
complete the EXCLUSION COMPUTATION on page 1.
STOP. The capital stock does not qualify .
NO
3 If you are a qualified spouse, were you married to the employee on the date of the sale of the capital stock or the date the dividend
was declared?
Complete the EXCLUSION COMPUTATION on page 1.
YES
STOP. The capital stock does not qualify .
NO
4 If a trust is claiming the exclusion, was trust created while the employee was living and are all the beneficiaries either the spouse or
descendants of the employee?
Complete the EXCLUSION COMPUTATION on page 1.
YES
STOP. The capital stock does not qualify .
NO
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