Department of the Treasury — Internal Revenue Service

Form 13657

(March 2005)

Notice of Election by Corporation to Participate in

Announcement 2005-19 Settlement Initiative

The Service can decline to execute a closing agreement with any party that fails to provide all

information requested within this Form 13657.

NOTE:

Section I. Corporation Information

Corporation name Corporation identification

number (EIN)

Address (Street, City, State, ZIP code)

Name and title of person to contact at corporation Daytime telephone number

FAX number

Corporation currently is in Appeals or Examination Yes (Please complete items 8 and 9.) No

Name and address (Street, City, State, ZIP code) of Appeals Officer or Agent Daytime telephone number

Corporation has executed a Power of Attorney Yes (Please attach a copy.) No

Identification number (EIN) for

Item 11 entries

Name of corporation(s) that received the services from the Executives named in Section III,

if different from corporation named in Item 1. (Attach additional sheets, if necessary.)

Did the Corporation file as part of a consolidated federal income tax

return for any taxable period affected by the terms of the settlement?

Yes (See Items 14 & 15 or Items 16 & 17,

 whichever is applicable.)

Corporation Attestation

The following Corporation elects to participate in the settlement initiative as described in Announcement 2005-19

and as contained in Internal Revenue Bulletin 2005-11 dated March 14, 2005. The Corporation is submitting with

this election the information and documents requested. Under penalties of perjury, I declare that I have

examined this Form 13657 and to the best of my knowledge and belief, it is true, correct and complete.

Corporation name Name of authorized Corporate Representative

Title

By (Signature of authorized Corporate Representative) Date

1. 2.

3.

4. 5.

6.

7.

8. 9.

10.

( )

( )

( )

11. 12.

13.

14.

No

Catalog No. 39566V Sheet 1 of 3 www.irs.gov Form 13657 (3-2005)

Name of the Corporation's parent that participated in the transaction (if the Corporation is a 15.

subsidiary)

Employer identification number

(EIN) for Item 14 entry

Name of the Corporation's subsidiary that participated in the transaction (if the Corporation

is the parent)

16. 17. Employer identification number

(EIN) for Item 16 entry
Section II. Election Information

Pursuant to section 3(b)(1) and section 3(c)(2) of Announcement 2005-19, the Corporation elects to claim the allowable

compensation deduction in its taxable year that includes ("X" only one):

the date(s) the stock options were transferred to the Related Person, or

December 31, 2004, or

December 31 of the year in which the Executive recognizes the compensation, or

Did the Corporation already claim a compensation deduction for any stock options or restricted stock that its Executives transferred

in Notice 2003-47 transactions?

Yes (See instructions below.) No

If "Yes," please attach a schedule listing the amounts and years of such deductions.

Did the Corporation already claim any deductions for transaction costs (i.e., fees paid to promoters, attorneys, accountants,

appraisers, or others) concerning Notice 2003-47 transactions?

Yes (See instructions below.)

If "Yes", please attach a schedule listing the amounts and years of such deductions. If the Corporation wishes to claim deductions

for such costs that have not been previously deducted, also attach a schedule\ listing the amounts and years of such fees and

attach documents substantiating payment.

Section III. Executive Information

For each Executive (Officer, Director, employee) who participated in a Notice 2003-47 transaction using either stock

options granted or restricted stock issued by the Corporation, please provide the following information. If you need

additional space for your answers, please attach additional sheets and identify the continued answers by item number.

Name and address (Street, City, State, ZIP code) of Executive Executive identification

number (SSN)

Name and address (Street, City, State, ZIP code) of Related Person to which the Executive

transferred the options or stock

Related Person identification

number (EIN)

Date(s) Executive transferred options or restricted stock to

Related Person

Date(s) such options were exercised or date(s) such

restricted stock vested

Was a Form 1099 or Form W-2 issued to the Executive upon the Executive's transfer of the options or the restricted stock to the

Related Person?

Yes (See instructions below.) No

If "Yes," please attach copies of the form and specify the amount representing the option or restricted stock value

included on the Form 1099 or Form W-2.

Was a Form 1099 or Form W-2 issued to the Executive upon the exercise of the options or the vesting of the restricted stock?

Yes (See instructions below.) No

If "Yes," please attach copies of the form and specify the amount representing the option or restricted stock value included on the

Form 1099 or Form W-2.

1.

2.

3.

1.

a.

b.

c.

d.

e.

the date(s) the options were exercised or the restricted stock vested, or

December 31 of the year determined under IRC section 3(c)(2) of Announcement 2005-19.

No

2.

3. 4.

5. 6.

7.

8.

Department of the Treasury – Internal Revenue Service

Catalog No. 39566V

Form 13657 (3-2005) Sheet 2 of 3 www.irs.gov
Section III. Executive Information — continued

Was any portion of the stock options or restricted stock awarded to the Executive in connection with the Executive's performance of

services for a subsidiary or affiliate of the Corporation?

Yes No

Is the Executive electing to participate in this settlement issue?

Unknown

9.

Yes No

10.

Department of the Treasury – Internal Revenue Service

Catalog No. 39566V

Form 13657 (3-2005) Sheet 3 of 3 www.irs.gov

Instructions

Send your completed Form 13657 to:

Internal Revenue Service

ATTN: Announcement 2005-19

MC 4166 NWSAT

4050 Alpha Road

Farmers Branch, TX 75244

If you are under examination or in Appeals, please

provide a copy of this Notice of Election to the

examining revenue agent or the Appeals Officer.

1.

2.