Iowa State University Property Receipt Form The purpose of this form is to provide a written acknowledgement from the recipient for property given by Iowa State University (ISU) for purposes other than the compensation of research participants. Research participants need to sign the Research Participant Receipt Forms specifically designed for that purpose. If the property (cash, gift cards, gift certificates, or other property) given has a value of $100.00 or more, the recipient must also provide his/her Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) and permanent address for the purpose of 1099-MISC reporting. A signature is required, even if the amount is less than $100.00. 1. I, _____________, have received  OR am requesting  compensation in the form (Printed Name)    and amount indicated below: Cash $________ Gift Certificate/Gift Card $________ Other Property $________ Description___________________________ 2. Are you an Iowa State University Employee?  Yes  No *If yes, a cash (check) payment should be made through Payroll. Send this form to 3. Record either your Social Security Number or your Individual Taxpayer Identification Number. (This information is required only if the property given has a value of $100.00 or more.) __ __ __ - __ __ - __ __ __ __ OR __ __ __ - __ __ - __ __ __ __ Social Security Number or Individual Taxpayer Identification Number Federal and state law protects the privacy and security of your SSN or ITIN, and ISU will not disclose your SSN or ITIN without your consent for any other purposes except as allowed by law. A Form 1099-MISC will not be submitted to the IRS unless all payments received from ISU in a calendar year are $600 or more. 4. Record your complete permanent address. (This information is required only if the property given has a value of $100.00 or more.) _________________________________________________________________ Address City State ZIP Code 5. Signature and Date (These are required, regardless of the amount.) ___________________________ (Signature) _____________________________________ (Email Address) ___/___/___ MM/DD/YYYY ______________________ (Phone Number) Your signature certifies that you are not subject to backup withholding due to failure to report interest and dividend income. It also certifies that you are a U.S. person, including a U.S. resident alien. If you are not a U.S. person, you must complete and attach IRS Form W-8BEN to apply for exemption from 30% backup withholding. TO ISU PERSONNEL: This form provides documentation for cash, gift certificates, gift cards, or other property given by ISU. If the property was purchased by an ISU Purchasing Card, keep the original form as part of your Purchasing Card documentation. If the amount is $100.00 or more, forward a copy of this form to Matt Devick, Accounting Office, 1520 ASB to meet IRS reporting requirements. Please provide the Worktag, date, and Workday reference number, so that we can link the Property Receipt Form to a specific expenditure. Workday Ref #_____________________________ If clearing petty cash, attach the Property Receipt Form to a Journal Entry in Workday. If documenting expenses for a reimbursement, attach the Property Receipt Form to the Expense Report in Workday.

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