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Form 13750 - Election To Participate In Announcement 2005-80 Settlement Initiative - 2005 Page 3

Page 3 of 4

Details of Settlement Initiative Transactions Elected by Taxpayer

Schedule A

(A separate Schedule A must by submitted for each transaction checked in Section II of Form 13750)

Indicate the notice, ruling or other transaction description for the box checked in Section II to which this Schedule A applies

1. Please provide a detailed description of your particular transaction, including a description of the relevant tax benefits

(Including, but not limited to income deferrals, deductions, credits, exclusions, and basis adjustments)

(If additional space is required, please include information on a separate attachment to this schedule)

2. Enter the applicable Tax Shelter Registration (or Material Advisor) number (if registered)

3. Transaction details

Type of Tax

Tax Years

Amount of Tax

Amount of Tax Benefits

Line Item Where

Date Tax

(income, excise,

Involved

at Issue

Benefit Claimed

Return Filed

Claimed on Tax Return

employment, etc.)

(If additional space is required, please include information on a separate attachment to this schedule)

4. Transaction costs (i.e. fees and other amounts paid to promoters, attorneys, accountants, appraisers, or others to plan and carry

out the transaction)

Transaction Costs paid to

Tax Years

Amount(s)

Involved

Paid

Name

Business

Address

Relationship

(If additional space is required, please include information on a separate attachment to this schedule)

5. Other parties to the transaction (including but not limited to the names of employees who are affected by an employer's transactions)

Party Name

EIN/SSN

Address

Daytime Phone Number

(If additional space is required, please include information on a separate attachment to this schedule)

6. Are your tax matters with respect to this elected transaction currently in litigation

Yes

7. Has the Service informed you it has designated (or is considering designation

Yes

of) your transaction for litigation

Yes

8. Are you currently a party to any bankruptcy proceeding

Catalog No. 47521K

13750

Form

(10-2005)

Form 13750 - Election To Participate In Announcement 2005-80 Settlement Initiative - 2005 Page 3

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