rom 2990 Election by a Small Business Corporation
(Rev. April 1988) (Under section 1362 of the Internal Revenue Code)
Department of the Treasury > For Paperwork Reduction Act Notice, see page 1 of instructions. Expires 2-28-91
Internal Revenue Service > See separate instructions.

OMB No. 1545-0146

Note: This election, to be treated as an “S corporation,” can be approved only if all the tests in Instruction B are met.

Election Information

Name of corporation (see instructions) ‘A Employer identification number B Principal business activity and
(ee instructions) principal product or service (see
x instructions)
«
5" Number and street Name and telephone number of corporate officer or legal representative
5 that may be called for information
3
= City or town, state, and ZIP code D Election is tobe effective for tax year beginning | E Date of incorporation
(month, day, year)
F Is the corporation the outgrowth or continuation of any form of predecessor? . . L] Yes [1 No| & Place of incorporation
if “Yes,” state name of predecessor, type of organization, and period of its existence P__..-.......---------
H__ If this election takes effect for the first tax year the corporation exists, enter the earliest of the following: (1) date the corporation first had shareholders,

(2) date the corporation first had assets, or (3) date the corporation began doing business (month, date, year).

Selected tax year: Annual return will be filed for tax year ending (month and day) >
See instructions before entering your tax year. If the tax year ends any date other than December 31, except for an automatic 52-53-week tax year
ending with reference to the month of December, you must complete Part Il on the back. If the date you enter in | is the ending date of an automatic
52-53-week tax year, write “52-53-week year” to the right of the date. See instructions.

J Name of each shareholder, person having a | K Shareholders’ Consent Statement. L Stock owned

community property interest in the corpora- | We, the undersigned shareholders, M__ Social security N Shareholder's
tion's stock, and each tenant in common, joint | consent to the corporation's number or employer tax year ends
tenant, and tenant by the entirety. (A husband | election to be treated as an “S identification number (month and
and wife (and their estates) are counted as | corporation” under section | Number of Dates (Gee instructions) day)
one shareholder in determining the number of || 1362(a). (Shareholders sign and ‘shares acquired

shareholders without regard to the manner in | date below.)*
which the stock is owned.)

*For this election to be valid, the consent of each shareholder, person having a community property interest in the corporation's stock, and
each tenant in common, joint tenant, and tenant by the entirety must either appear above or be attached to this form. (See instructions for
Column K, if continuation sheet or a separate consent statement is needed.)

Under penalties of perjury, | declare that | have examined this election, including accompanying schedules and statements, and to the best of my knowledge and belef, it is true,
correct, and complete.

Signature and

Title of Officer > Date >

‘See Parts Il and Ill on back. Form 2553 (Rev. 4-88)



Form 2553 (Rev. 4-88) Page 2

GEGHI] Selection of Tax Year (See Instructions for required attachments and other details.)

© Check the applicable box below to indicate whether the corporation is:
1 adopting the tax year entered in item 1, Part I.
C1 Retaining the tax year entered in item |, Part |.
C1 Changing to the tax year entered in item I, Part |.
P Check the applicable box below to indicate the representation statement the corporation is making as required under section 4 of Revenue Procedure
87-32, 1987-2 C.B. 396.
1 under penalties of perjury, | represent that shareholders holding more than half of the shares of the stock (as of the first day of the tax year to which
the request relates) of the corporation have the same tax year or are concurrently changing to the tax year that the corporation adopts, retains, or
changes to per item |, Part I. | also represent that the corporation is not described in section 3.01(2) of Revenue Procedure 87-32.

C1 under penalties of perjury, | represent that the corporation is retaining or changing to a tax year that coincides with its natural business year as.
defined in section 4.01(1) of Revenue Procedure 87-32 and as verified by its satisfaction of the requirements of section 4.02(1) of Revenue
Procedure 87-32. In addition, if the corporation is changing to a natural business year as defined in section 4.01(1), | further represent that such
tax year results in less deferral of income to the owners than the corporation's present tax year. | also represent that the corporation is not
described in section 3.01(2) of Revenue Procedure 87-32. (See instructions for Part II for attachments required by section 4.03(3) of Revenue
Procedure 87-32.)

Note: /f you do not use item P and the corporation wants a fiscal tax year, then complete either item Q or R. Item Q is used to request a fiscal tax year based
on business purpose and to make a back-up section 444 election. Item R is used to make a regular section 444 election. See cautionary statement in
instructions regarding back-up calendar year election.

Q Check the applicable box(es):
Check here [] ifthe fiscal year entered in item |, Part I, is requested under the provisions of section 6.03 of Revenue Procedure 87-32. Attach to
Form 2553 a statement and other necessary information pursuant to the ruling request requirements of Revenue Procedure 88-1, 1988-1 |.R.B. 7. The
statement must include the business purpose for the desired fiscal year. Check here [“] to show the corporation intends to make a back-up section
444 election in the event the corporation's business purpose request is not approved by the IRS.
Check here [_] to show that the corporation agrees to adopt or change to a tax year ending December 31 if necessary for the IRS to accept this
election for S corporation status in the event: (1) the corporation's business purpose request is not approved and the corporation makes a back-up
section 444 election, but is ultimately not qualified to make a section 444 election, or (2) the corporation's business purpose request is not approved
and the corporation did not make a back-up section 444 election.

R_ Check the applicable box(es):
Check here [_] to show the corporation will make, if qualified, a section 444 election to have the fiscal tax year shown in Part I, item I. The corporation
makes the election by completing Form 8716, Election To Have a Tax Year Other Than a Required Tax Year, and either attaching it to Form 2553 or
filing it in accordance with the instructions for Form 8716.

Check here [] to show that the corporation agrees to adopt or change toa tax year ending December 31 if necessary for the IRS to accept this
election for S corporation status in the event the corporation is ultimately not qualified to make a section 444 election.

GEM Qualified Subchapter S Trust (QSST) Election Under Section 1361(d)(2)**

Income beneficiary's name and address Taxpayer identification number

Trust's name and address Taxpayer identification number

Date on which stock of the corporation was transferred to the trust (month, date, year) >

In order for the trust named above to be a QSST and thus a qualifying shareholder of the S corporation for which this Form 2583 is filed, | hereby make the
election under section 1361(d)(2). Under penalties of perjury, | certify that the trust meets the definition requirements of section 1361(d)(3) and that all
other information provided in Part Ill is true, correct, and complete.

Signature of income beneficiary or signature and title of legal representative or other qualified person making the election Date

**The use of Part Ill to make the QSST election can be made only if stock of the corporation has been transferred to the trust on or before the date on which
the corporation makes its election to be an S corporation, and if the QSST election and the Form 2553 election have the same effective date. The QSST
election can also be made and filed separately as specified in Regulations section 1.1361-1A(i)(3). The QSST election has to be made separately as
specified in Regulations section 1.1361-1A(j)(3) if the stock transfer and S election have not been made as stated above.