Form 13657 - Notice Of Election By Corporation To Participate In Announcement 2005-19 Settlement Initiative Page 3

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Section III. Executive Information — continued
9.
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
10.
Is the Executive electing to participate in this settlement issue?
Yes
No
Unknown
Instructions
1.
Send your completed Form 13657 to:
Internal Revenue Service
ATTN: Announcement 2005-19
MC 4166 NWSAT
4050 Alpha Road
Farmers Branch, TX 75244
2.
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.
13657
Sheet 3 of 3
Department of the Treasury – Internal Revenue Service
Form
(3-2005)
Catalog No. 39566V

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