Department of the Treasury — Internal Revenue Service

Form 13656 Notice of Election by Executive and Related Person to

Participate in Announcement 2005-19 Settlement Initiative (March 2005)

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

information requested within this Form 13656.

Section I. Executive Information

1. Executive name (and name of spouse, if joint return) 2. Social security number (SSN)

(Executive)

(Spouse)

3. Address (Street, City, State, ZIP code) 4. Daytime telephone number

5. FAX number

6. Executive currently is in Appeals or Examination 7. Executive has executed a Power of Attorney

Yes (Please complete items 8 and 9.) No Yes (Please attach a copy.) No

8. Name and address (Street, City, State, ZIP code) of Appeals Officer or Agent

I elect 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. I am

submitting with this election the information and documents requested. Under penalties

of perjury, I declare that I have examined this Form 13656 and to the best of my

knowledge and belief, it is true, correct and complete.

Executive

Attestation

Signature of Executive Date

Section II. Related Person Information

1. Name of Related Person to which stock options or restricted stock were transferred 2. Related Person identification

3. Address (Street, City, State, ZIP code) 4. Daytime telephone number

5. FAX number

6. Related Person has executed a Power of Attorney Yes (Please attach a copy.) No

Catalog No. 39565K Sheet 1 of 4 www.irs.gov Form 13656 (3-2005)

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9. Daytime telephone number

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number (EIN)

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Section II. Related Person Information — continued

Related Person Attestation

All partners/members of the Related Person elect 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.

Under penalties of perjury, I declare that I have examined this Form 13656 and to the best of my

knowledge and belief, it is true, correct and complete.

Name (Please print.) Signature Date

1 .

Name (Please print.) Signature Date

2.

Name (Please print.) Signature Date

3.

Name (Please print.) Signature Date

4.

Name (Please print.) Signature Date

5.

Name (Please print.) Signature Date

6.

Name (Please print.) Signature Date

7.

Name (Please print.) Signature Date

8.

Section III. Corporation Information

1. Name of corporation that issued the stock options or restricted stock 2. Corporation identification

3. Address (Street, City, State, ZIP code) 4. Daytime telephone number

5. FAX number

6. Is the corporation electing to participate in this settlement initiative? Yes No Unknown

7. Name of corporation that received the services from the Executive (if different from the 8. Corporation identification

9. Address (Street, City, State, ZIP code)

Department of the Treasury – Internal Revenue Service

number (EIN)

corporation named in Section III, Item 1) number (EIN)

10. Daytime telephone number

11. FAX number

Catalog No. 39565K

Form 13656 (3-2005) Sheet 2 of 4 www.irs.gov

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Information and Documentation Required to Process Election by

Executive and Related Person Section IV.

Answer the following questions and provide the listed documentation. If you need additional space for your answers,

please attach additional sheets and identify the continued answers by item number. “Provide documentation” means

“Attach copies of documents that verify your responses.”

What did the Related Person transfer to the Executive in exchange for the stock options or restricted stock the Executive

transferred to the Related Person? On what date(s) did the transfer or sale occur? Provide documentation (including copies of any

promissory notes and appraisal reports).

On what date(s) did the Related Person exercise stock options it received from the Executive? Does the Related Person still hold

options it has not exercised?

What was the fair market value of the stock on the exercise date or the date of vesting? Provide documentation.

Has the Related Person paid any amounts (including interest) to

the Executive?

Did the Related Person or the Executive pay any transaction

costs (including promoter, accounting, appraisal, and legal fees)?

Has the Related Person sold all the stock it acquired through this transaction (including stock acquired by exercising options)?

Yes (See below.) No

For any stock sold, provide a schedule listing the number of shares sold, the date of sale, the sales price, and the claimed basis

at the date of sale. Provide documentation.

Provide copies of all promotional packages, legal opinions, or engagement letters obtained by the Executive or the Related Person

(or any person acting on their behalf) pertaining to this transaction.

Provide the name, address, and telephone number of the entity and person(s) that sold or promoted the sale of the transaction

described in Announcement 2005-19 to the Executive or the Related Person.

Provide a computation of any tax and penalty due from the Executive under the terms of Announcement 2005-19.

Provide a computation of the Related Person's basis in stock still held pursuant to Announcement 2005-19.

1.

2.

Yes No (Or, on what date did the restricted stock vest?)

3.

Yes (Provide documentation of all payments.)

No

4.

Yes (Provide documentation of all payments.)

No

5.

Note:

6.

7.

8.

9.

Department of the Treasury – Internal Revenue Service

Catalog No. 39565K

Form 13656 (3-2005) Sheet 3 of 4 www.irs.gov
Information and Documentation Required to Process Election by

Executive and Related Person Section IV. — continued

Provide a computation of any change in the tax liability of the Related Person as a result of this Election.

Provide copies of all federal tax returns filed by the Related

Person and the Executive from the date the options or

restricted stock was transferred to the Related Person to the

present.

Is the Executive or Related Person currently in tax litigation

with the government?

Yes No

Provide a schedule listing the names, addresses, and SSNs

of the following:

Has the Executive filed a Qualified Amended Return (as defined

by Treas. Reg. §1.6664-2(c)(3)) pertaining to the transaction?

a.

The spouses of partners or other members of pass- Yes (Provide a copy.)

through entities who filed joint returns for any taxable

period affected by the terms of the settlement.

Has the Executive or the Related Person received a Form W-2

or Form 1099 pertaining to the transaction?

Has the Executive filed a disclosure statement pertaining

to the transaction pursuant to Announcement 2002-2?

Instructions

Send your completed Form 13656 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.

10.

11. 12.

13. 14.

15. 16.

No

All partners or members of the Related Person and

b.

Yes (Provide a copy.) No Yes (Provide a copy of all forms.) No

1.

2.

(Provide a copy of the complaint

or the Tax Court petition.)

Department of the Treasury – Internal Revenue Service

Catalog No. 39565K

Form 13656 (3-2005) Sheet 4 of 4 www.irs.gov