83(b) Election for an LLC

83(b) ELECTION for an LLC

This statement is being made under Section 83(b) of the Internal Revenue Code pursuant to Treas. Reg. Section 1.83-2.

(1) The name, address and taxpayer identification number of the undersigned are:

Name:  [Member Name]
Address:  [Member Address]
Social Security Number:  [Member Social Security]

(2) Description of the property with respect to which the election is being made:

___ Membership Interests of [Company Name], LLC (the “Company”).

(3) The date on which property was transferred was [Date of Grant].  The taxable year in which the election is being made is [Tax Year].

(4) The nature of the restrictions to which the property is subject is:

The Interests are subject to forfeiture and cancellation if the undersigned’s services to the Company are terminated for any reason.  These forfeiture restrictions lapse with respect to one third of the Interests on each of the first three anniversaries of the initial grant date.  As a result, the Interests remain subject to risk of forfeiture.

(5) Fair market value:

The fair market value at the time of transfer (determined without regard to any restriction other than restrictions that by their terms will never lapse) of the property with respect to which this election is being made is $0.00.

(6) Amount (if any) paid for the property.

The amount paid by the taxpayer for the property is $0.00 in the aggregate.

(7) Furnishing statement:

A copy of this statement was furnished to [Company Name], LLC.

Dated:  [Date]