Instructions to Complete IRS 83(b) Election

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1 Instructions to Complete IRS 83(b) Election IRS FILING POSTMARK DEADLINE: 30 days after [[Date of Stock Purchase Agreement]] Page Item 1 Instructions 2 IRS Transmittal Letter (b) Election form Copy 1, Copy 2, Copy 3, Copy 4 NOTE: STEP 1: An 83(b) Election is necessary only for unvested shares. If all shares are fully vested upon issuance, no 83(b) Election is necessary. COMPLETE THE FOUR ENCLOSED 83(b) ELECTION FORMS* On all 4 copies of the 83(b) Election forms in this packet, make any necessary corrections or additions. Where indicated: Insert the date the 83(b) Election form is signed by the taxpayer Insert the taxpayer identification number (TIN) for the taxpayer (and spouse, if applicable). For most individuals, your TIN is your Social Security Number. Manually sign where indicated (including spouse, if applicable) STEP 2: SEND TWO COPIES TO THE IRS Include the following in a single envelope: 1. Transmittal Letter 2. Copy 1 of the signed original 83(b) Election form 3. Copy 2 of the signed 83(b) Election form o Clip a single self-addressed, postage paid envelope to Copy 2 of the 83(b) Election form for the IRS to return a date-stamped copy. Obtaining a date-stamped copy is not required and the IRS is inconsistent about returning them. Nevertheless, it is recommended to request it simply to enhance the company s and taxpayer s records. Send by USPS Certified Mail with Return Receipt requested to the IRS mailing address where you file your annual income tax return. See Addresses-for-Tax-Professionals o If you must use a private delivery service, check IRS requirements and be sure to obtain written proof of the mailing date that complies with IRS rules. See Keep in the company s and taxpayer s files a copy of the USPS Certified Mail Receipt and Return Receipt and the date-stamped copy if it is returned by the IRS. STEP 3: FURNISH ONE COPY TO THE COMPANY Furnish Copy 3 of the signed 83(b) Election form to the Company. STEP 4: KEEP ONE COPY & FILE WITH [[Tax Year of Stock Issuance]] TA RETURN Retain Copy 4 of the signed 83(b) Election form in the taxpayer s records. As required by IRS rules, include a copy of the 83(b) Election form with taxpayer s [[Tax Year of Stock Issuance]] income tax return. * Four copies are provided for your convenience. Alternatively, you may complete a single form and make three photocopies to complete these Instructions. The original signed 83(b) Election form should be filed with the IRS.

2 VIA CERTIFIED MAIL IRS TRANSMITTAL LETTER (TAPAYER: ENCLOSE COPY 1 & COPY 2, INCLUDE POSTAGE PAID ENVELOPE AND ADDRESS TO IRS SERVICE CENTER WHERE YOU FILE ANNUAL INCOME TA RETURN) Internal Revenue Service Center Re: Election Under Section 83(b) of the Internal Revenue Code of 1986 Ladies and Gentlemen: For filing with the Internal Revenue Service, please find enclosed two copies of the document entitled Election Under Section 83(b) of the Internal Revenue Code of 1986 (the Election ). Kindly acknowledge receipt and filing of the Election by date-stamping the additional Election and returning it to the undersigned in the courtesy postage paid envelope provided for your convenience. If you have any questions regarding this matter, please do not hesitate to contact the undersigned. Thank you for your courteous assistance in this matter. Very truly yours, [[Taxpayer Signature Block]] Enclosures 1. Election Copy 1 For IRS filing 2. Election Copy 2 Date stamp and return to taxpayer in postage paid envelope

3 COPY 1 IRS (FILE COPY) (TAPAYER: DATE, SIGN AND INSERT TAPAYER ID NUMBER) file this election with the Internal Revenue Service office with which Taxpayer s annual income furnish a copy of this election to the Company for whom the services were performed include a copy of this election with Taxpayer s income tax return for the taxable year in which TAPAYER: TAPAYER SPOUSE (IF APPLICABLE): - Manually date, sign and insert Taxpayer ID Number where indicated.

4 COPY 2 IRS (RETURN COPY) (TAPAYER: DATE, SIGN & INSERT TAPAYER ID NUMBER. ATTACH POSTAGE PAID ENVELOPE) (IRS: DATE STAMP & RETURN TO TAPAYER) file this election with the Internal Revenue Service office with which Taxpayer s annual income furnish a copy of this election to the Company for whom the services were performed include a copy of this election with Taxpayer s income tax return for the taxable year in which TAPAYER: TAPAYER SPOUSE (IF APPLICABLE): - Manually date, sign and insert Taxpayer ID Number where indicated.

5 COPY 3 COMPANY (TAPAYER: DATE, SIGN & INSERT TAPAYER ID NUMBER) file this election with the Internal Revenue Service office with which Taxpayer s annual income furnish a copy of this election to the Company for whom the services were performed include a copy of this election with Taxpayer s income tax return for the taxable year in which TAPAYER: TAPAYER SPOUSE (IF APPLICABLE): - Manually date, sign and insert Taxpayer ID Number where indicated.

6 COPY 4 TAPAYER (TAPAYER: DATE, SIGN & INSERT TAPAYER ID NUMBER. INCLUDE COPY WITH [[Tax Year of Stock Issuance]] TA RETURN) file this election with the Internal Revenue Service office with which Taxpayer s annual income furnish a copy of this election to the Company for whom the services were performed include a copy of this election with Taxpayer s income tax return for the taxable year in which TAPAYER: TAPAYER SPOUSE (IF APPLICABLE): - Manually date, sign and insert Taxpayer ID Number where indicated.

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