Form Il-4644 - Gains From Sales Of Employer'S Securities Received From A Qualified Employee Benefit Plan
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Illinois Department of Revenue
Gains from Sales of Employer’s Securities
IL-4644
Received from a Qualified Employee Benefit Plan
Attach this form and a copy of your Federal Schedule D to your Form IL-1040 or Form IL-1041.
IL Attachment No. 20
Step 1: Provide the following information
1
This form is for calendar year
or other taxable year beginning
and ending
.
Year
Month
Year
Month
Year
2
Write your name as shown on your Form IL-1040 or Form IL-1041.
3
Write your Social Security number or federal employer identification number.
4
Check one
Individual
Estate or trust
Step 2: Provide general security information
Column A
Column B Column C
Column D
Description of security
Date distributed
Date sold
Federal gain
(List each sale separately)
(month, year)
(month, year)
on disposition
5
________
_____________ 00
6
________
_____________ 00
7
________
_____________ 00
8
________
_____________ 00
Step 3: Calculate net unrealized appreciation
Column E
Column F
Column G
Column H
Market value of stock
Federal tax basis of stock
Excess of Column E over Column F
Lesser of Columns G or D
on date of distribution
on date of distribution
(if any)
(See instructions.)
(See instructions.)
9 ________
________
________
________
_____________ 00
_____________ 00
_____________ 00
_____________ 00
1 0 _ _______
________
________
________
_____________ 00
_____________ 00
_____________ 00
_____________ 00
1 1 _ _______
________
________
________
_____________ 00
_____________ 00
_____________ 00
_____________ 00
1 2________
________
________
________
_____________ 00
_____________ 00
_____________ 00
_____________ 00
1 3
13 ________
Write the total here and on Form IL-1040, Line 5 or Form IL-1041, Line 14.
_____________ 00
If you must file a Schedule F (because Line 18 below is a gain), also write this amount on Form IL-1040, Schedule F, Line 13, or
Form IL-1041, Schedule F, Line 14.
Step 4: Identify securities received in a distribution prior to August 1, 1969
Column I
Column J
Column K
Column L
Column M
August 1, 1969, value
Federal tax basis
Excess of Column I over
The greater of Columns H or K
Subtract Column H
(See instructions.)
August 1, 1969
Column J (if any)
but not greater than Column D
from Column L
(See instructions.)
14
_
_
_
_
_ ________________
_____________ 00
_____________ 00
_____________ 00
_____________ 00
1 5
_
_
_
_
_ ________________
_____________ 00
_____________ 00
_____________ 00
_____________ 00
16
_
_
_
_
_ ________________
_____________ 00
_____________ 00
_____________ 00
_____________ 00
17
_
_
_
_
_________________
_____________ 00
_____________ 00
_____________ 00
_____________ 00
18 Total
18 _
_____________ 00
If this amount is a gain, you must complete Schedule F. Write this amount on Form IL-1040, Schedule F, Line 3 or Form IL-1041, Schedule F, Line 3.
*161801110*
This form is authorized as outlined under the Illinois Income Tax Act. Disclosure of
IL-4644 front (R-12/11)
this information is required. Failure to provide information could result in a penalty.
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