Form 13657 - Notice Of Election By Corporation To Participate In Announcement 2005-19 Settlement Initiative Page 2
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1
2
3Section II.
Election Information
1.
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)
a.
the date
the stock options were transferred to the Related Person, or
(s)
b.
the date
the options were exercised or the restricted stock vested, or
(s)
c.
December 31, 2004, or
d.
December 31 of the year in which the Executive recognizes the compensation, or
e.
December 31 of the year determined under IRC section 3(c)(2) of Announcement 2005-19.
2.
Did the Corporation already claim a compensation deduction for
stock options or restricted stock that its Executives transferred
any
in Notice 2003-47 transactions?
Yes
No
(See instructions below.)
If "Yes," please attach a schedule listing the amounts and years of such deductions.
3.
Did the Corporation already claim
deductions for transaction costs
any
(i.e., fees paid to promoters, attorneys, accountants,
concerning Notice 2003-47 transactions?
appraisers, or others)
Yes
No
(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
who participated in a Notice 2003-47 transaction using either stock
(Officer, Director, employee)
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.
1.
Name and address
of Executive
2.
Executive identification
(Street, City, State, ZIP code)
number
(SSN)
3.
Name and address
of Related Person to which the Executive
4.
Related Person identification
(Street, City, State, ZIP code)
transferred the options or stock
number
(EIN)
5.
Date
Executive transferred options or restricted stock to
6.
Date
such options were exercised or date
such
(s)
(s)
(s)
Related Person
restricted stock vested
7.
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
No
(See instructions below.)
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.
8.
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
No
(See instructions below.)
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.
13657
Sheet 2 of 3
Department of the Treasury – Internal Revenue Service
Form
(3-2005)
Catalog No. 39566V
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