S-Corporation Shareholder's Consent To Initial Election
The undersigned, being a shareholder of ______________________, a ____________ corporation,
hereby consents to the election of that corporation, made on Internal Revenue Service Form 2553 to which this statement is attached, to be treated as a small business corporation under Section 1362(a) of the Internal Revenue Code of 1954.
The name and address of the corporation are: ________________, ________________.
The corporation's tax-payer identification number is: ______________.
The undersigned shareholder's name and address and tax-payer identification number are as follows:
Name and Address Taxpayer Identification No.
The number of shares owned by the undersigned shareholder, and the date or dates when the undersigned shareholder acquired those shares, are as follows:
Number of Shares Date (s) Acquired