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Iowa online Form 3921: What You Should Know

You must report this transfer to us. You are an eligible employee if (1) you have been the employee of such employer for at least a year, (2) you have at least 1,500 of restricted stock from such employer, or (3) you have a spouse or dependent child who does not have at least 1,500 of restricted stock. Furthermore, you are not an eligible employee if you, or your spouse or dependent child does not meet either of the previous two criteria. The eligible employee is allowed to designate one person to provide the report and sign it for him or her. Please see Instructions for Form 3911 to determine your options if your employer did not transfer your stock; however, an employee is not eligible for this form if the employer did not transfer any of his or her restricted stock. Your eligibility statement will also provide a statement that any information you provide will be confidential. We will mail you instructions by certified mail or by regular mail. If you do not receive it, please check your junk/spam mail folder and then call Iowa Sales Tax for a copy. This form will only recognize qualified persons and will not recognize: A former spouse (if you married prior to September 21, 2013); A person related to you by blood or marriage (if you are a stepchild, grandchild, brother, sister, aunt, uncle, niece, nephew, or niece); A corporation, or any division or affiliated company (if your employer is a foreign corporation); A partnership (if you are in a partnership); A personal representative; or An estate. Note: If your stock is held through a corporation, its shareholders will not be considered a qualified person for this purpose if the corporation has a corporate headquarters in another state and does not establish a principal place of business in Iowa. If qualified, you should provide the following information on the last page of Form 3921: The name of the employer (or transfer agent) and the name and address of the transferor (the person that transferred your stock to you). If you are not the transferor, you can omit this information. The total amount of restricted stock you held, the date you ceased to be the employee of the employer because you resigned or were terminated, and whether you are the employer, co-employer, or a stockholder of the employer (or of one of its related corporations).

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