Form 2553 - Election By A Small Business Corporation Page 2
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Form 2553 (Rev. 12-2017)
Page
Name
Employer identification number
Part I
Election Information (continued) Note: If you need more rows, use additional copies of page 2.
K
Shareholder’s Consent Statement
Under penalties of perjury, I declare that I
consent to the election of the above-named
corporation (entity) to be an S corporation
under section 1362(a) and that I have
examined this consent statement, including
L
accompanying documents, and, to the best
Stock owned or
of my knowledge and belief, the election
percentage of ownership
contains all the relevant facts relating to the
(see instructions)
election, and such facts are true, correct,
and complete. I understand my consent is
binding and may not be withdrawn after the
corporation (entity) has made a valid
election. If seeking relief for a late filed
election, I also declare under penalties of
perjury that I have reported my income on all
M
affected returns consistent with the S
Social security
corporation election for the year for which
J
N
number or
the election should have been filed (see
Name and address of each
Number of
employer
Shareholder’s
beginning date entered on line E) and for all
shareholder or former shareholder
shares or
identification
tax year ends
subsequent years.
required to consent to the election.
percentage
Date(s)
number (see
(month and
(see instructions)
Signature
Date
of ownership
acquired
instructions)
day)
2553
Form
(Rev. 12-2017)
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