Schedule                                  Sale of Investment in a
                  QI                   Qualified Wisconsin Business
          Wisconsin                                                                                                       2024
Department of Revenue                        Include with Wisconsin Form 1 or 1NPR
Name(s) shown on Form 1 or 1NPR                                                                                           Your social security number

Read instructions before filling in this schedule.

1     Date investment sold
                                m   m  d      d y     y       y                   y
2     Purchase date of the initial investment in the qualified Wisconsin business
       (The date must be after 12-31-2010, see Line 2 instructions.)                          m m        d             d  y y y y
3     Type of investment (check one)          Stock purchase                       Partnership interest                   LLC membership
       (If the investment was in a single member LLC, see General Instructions.)

4     Fill in the name and FEIN of the qualified Wisconsin business. (Do NOT enter the broker’s information.)
       Entity name 
        FEIN

4a   If a pass-through entity sold the investment, fill in the name and FEIN of the pass-through entity.
       (See Line 4a instructions.)
       Entity name
        FEIN

5     Sales price of investment as reported on federal Form 8949  ....................                                 5         .00

6     Cost or other basis adjusted for Wisconsin.
       (Wisconsin basis must be reduced for deferred long-term gain, see Line 6 instructions.)                         6         .00

7     Deferred long-term gain included in the investment   .............................                               7         .00

8     Add line 6 and line 7  ...................................................                                       8         .00

9     Subtract line 8 from line 5  ...............................................                                     9         .00

 Non-Taxable Long-Term Gain
    10Amount you computed to be non-taxable qualified gain.  (See                  Line 10 instructions.)
       (Enter on line 15a of Schedule WD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  10        .00

 Taxable Long-Term Gain
    11Add line 6 and line 10  ..................................................                                       11        .00

    12Net taxable long-term gain or (loss).  Subtract line 11 from line 5  .................                           12        .00

I-077 (R. 7-24)