83(b) Election For Corporation

ELECTION UNDER SECTION 83(b) OF THE INTERNAL REVENUE CODE OF 1986

The undersigned taxpayer hereby elects, pursuant to Section 83(b) of the Internal Revenue Code, to include in taxpayer’s gross income or alternative minimum taxable income, as applicable, for the current taxable year, the amount of any income that may be taxable to taxpayer in connection with taxpayer’s receipt of the property described below:

1.      The name, address, taxpayer identification number and taxable year of the undersigned are as follows:

·         NAME OF TAXPAYER:      [Founder Name]

·         NAME OF SPOUSE:         [Spouse Name]

·         ADDRESS:                         [Founder Address]

·         IDENTIFICATION NO. OF TAXPAYER:             [Founder Social Sercurity]

·         IDENTIFICATION NO. OF SPOUSE:                [Spouse Social if applicable]

·         TAXABLE YEAR:              [Taxable Year]

2.      The property with respect to which the election is made is described as follows: [Founder Purchased Shares] shares of the Common Stock of [Company Name] (the “Company”).

3.      The date on which the property was transferred is:  [Stock Sale Date]

4.      The property is subject to the following restrictions: Repurchase option at cost in favor of the Company upon termination of taxpayer’s employment or consulting relationship.

5.      The fair market value at the time of transfer, determined without regard to any restriction other than a restriction which by its terms will never lapse, of such property is:  $ [Stock Purchase Price].

6.      The amount (if any) paid for such property:  $ [Stock Purchase Price].

The undersigned has submitted a copy of this statement to the person for whom the services were performed in connection with the undersigned’s receipt of the abovedescribed property.  The transferee of such property is the person performing the services in connection with the transfer of said property.

The undersigned understands that the foregoing election may not be revoked except with the consent of the Commissioner.