ILLINOIS DEPARTMENT OF REVENUE 

                    DRAFT FORM 

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IDR-1-DIS (N-08/23)          Printed by authority of State of Illinois, web only – one copy. 
 

                                                                                         *61812191V*
     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 Enter your name as shown on your Form IL-1040 or Form IL-1041.  

 3 Enter your Social Security number (SSN) or federal employer identification number (FEIN).  

 4 CheckTENTATIVEone              Individual                  Estate or trust                                                                       FINAL

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            Column E minus Column F                                   Lesser of Columns G or D
     on date of distribution.                       on date of distribution.             (If Column F is greater than                    
        See instructions.                                See instructions.                         Column E, enter zero.)               

  9                               00                                           00                                                   00                                                     00
  10                              00                                           00                                                   00                                                     00
  11                              00                                           00                                                   00                                                     00
  12                              00                                           00                                                   00                                                     00
13  Enter the total here and on Form IL-1040, Line 5 or Form IL-1041, Line 14.                                                                   13                                        00
  If you must file a Schedule F (because Line 18 below is a gain), also enter 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                        Column I minus Column J The greater of Columns H or K                        Subtract Column H     
     or applicable fraction.      August 1, 1969.               or fraction in Column I times      but not greater than Column D                        from Column L                                 
     See instructions.            See instructions.             Column D. See instructions.
                                                                                         
14                                                       00                              00                                                     00                                       00
  15                                                     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. Enter this amount on Form IL-1040, Schedule F, Line 3 or Form IL-1041, Schedule F, Line 3.

                                          This form is authorized as outlined under the Illinois Income Tax Act.  Disclosure of                 Printed by the authority of the state
     IL-4644 (R-12/19)                    this information is required.  Failure to provide information could result in a penalty.              of Illinois - electronic only - one copy.