Restricted Stock Plan

Report your participation in a restricted stock plan in Part 3.  In addition, report the restricted stock in Part 2 (see Part 2 of this guide for details).

Employer or Party


Status and Terms


Icebox Repair Company

Stowe, VT

I will forfeit my unvested restricted stock upon my separation.


For You

Part 3

Report your participation in a restricted stock plan.  In addition, if you are an Annual or Termination filer, report a restricted stock plan in which you participated at any point during the reporting period.

Employer or Party:  Provide the name of the employer.

City/State:  Provide the city and state in which the employer is located.

Status and Terms:  Identify the plan as a restricted stock plan and describe what will happen (or has happened) to your restricted stock (e.g., retention, forfeiture of unvested restricted stock, acceleration of vesting prior to entering government service, etc.).  If applicable, specify the timeframe in which these actions will occur.

Date:  Provide the month and year in which you began participating in the restricted stock plan.