Form 2553

(Rev. December 2007)

Election by a Small Business Corporation
(Under section 1362 of the Internal Revenue Code) OMB No. 1545-0146
©
See Parts II and III on page 3 and the separate instructions.
Department of the Treasury
Internal Revenue Service © The corporation can fax this form to the IRS (see separate instructions).
Note. This election to be an S corporation can be accepted only if all the tests are met under Who May Elect on page 1 of the instructions; all
shareholders have signed the consent statement; an officer has signed below; and the exact name and address of the corporation and other
required form information are provided.

Part I Election Information

Name (see instructions) A Employer identification number

Type Number, street, and room or suite no. (If a P.O. box, see instructions.) B Date incorporated
or Print
City or town, state, and ZIP code C State of incorporation

D Check the applicable box(es) if the corporation, after applying for the EIN shown in A above, changed its name or address
E Election is to be effective for tax year beginning (month, day, year) (see instructions) © / /
Caution. A corporation (entity) making the election for its first tax year in existence will usually enter the
beginning date of a short tax year that begins on a date other than January 1.
F Selected tax year:
(1) Calendar year
(2) Fiscal year ending (month and day) ©
(3) 52-53-week year ending with reference to the month of December
(4) 52-53-week year ending with reference to the month of ©
If box (2) or (4) is checked, complete Part II
G If more than 100 shareholders are listed for item J (see page 2), check this box if treating members of a family as one
shareholder results in no more than 100 shareholders (see test 2 under Who May Elect in the instructions) ©
H Name and title of officer or legal representative who the IRS may call for more information I Telephone number of officer
or legal representative
( )
If this S corporation election is being filed with Form 1120S, I declare that I had reasonable cause for not filing Form 2553
timely, and if this election is made by an entity eligible to elect to be treated as a corporation, I declare that I also had
reasonable cause for not filing an entity classification election timely. See below for my explanation of the reasons the
election or elections were not made on time (see instructions).

Under penalties of perjury, I declare that I have examined this election, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete.
Sign
Here
© Signature of officer Title Date

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 18629R Form 2553 (Rev. 12-2007)
Form 2553 (Rev. 12-2007) Page 2
Part I Election Information (continued)
K
J Shareholders’ Consent Statement. L
Name and address of each Under penalties of perjury, we declare that we consent to the Stock owned or
shareholder or former election of the above-named corporation to be an S corporation percentage of ownership M
shareholder required to N
under section 1362(a) and that we have examined this consent (see instructions) Social security Shareholder’s
consent to the election. statement, including accompanying schedules and statements, number or employer tax year ends
(See the instructions for and to the best of our knowledge and belief, it is true, correct, and identification number (month and
column K.) complete. We understand our consent is binding and may not be Number of
Date(s) (see instructions) day)
withdrawn after the corporation has made a valid election. (Sign shares or
and date below.) percentage acquired
of ownership
Signature Date

Form 2553 (Rev. 12-2007)

Form 2553 (Rev. 12-2007) Page 3
Part II Selection of Fiscal Tax Year (see instructions)
Note. All corporations using this part must complete item O and item P, Q, or R.
O Check the applicable box to indicate whether the corporation is:
1. A new corporation adopting the tax year entered in item F, Part I.
2. An existing corporation retaining the tax year entered in item F, Part I.
3. An existing corporation changing to the tax year entered in item F, Part I.
P Complete item P if the corporation is using the automatic approval provisions of Rev. Proc. 2006-46, 2006-45 I.R.B. 859, to request (1) a
natural business year (as defined in section 5.07 of Rev. Proc. 2006-46) or (2) a year that satisfies the ownership tax year test (as defined in
section 5.08 of Rev. Proc. 2006-46). Check the applicable box below to indicate the representation statement the corporation is making.
1. Natural Business Year © I represent that the corporation is adopting, retaining, or changing to a tax year that qualifies as its natural
business year (as defined in section 5.07 of Rev. Proc. 2006-46) and has attached a statement showing separately for each month the gross
receipts for the most recent 47 months (see instructions). I also represent that the corporation is not precluded by section 4.02 of Rev. Proc.
2006-46 from obtaining automatic approval of such adoption, retention, or change in tax year.

2. Ownership Tax Year © I represent that shareholders (as described in section 5.08 of Rev. Proc. 2006-46) holding more than half of
the shares of the stock (as of the first day of the tax year to which the request relates) of the corporation have the same tax year or are
concurrently changing to the tax year that the corporation adopts, retains, or changes to per item F, Part I, and that such tax year satisfies
the requirement of section 4.01(3) of Rev. Proc. 2006-46. I also represent that the corporation is not precluded by section 4.02 of Rev. Proc.
2006-46 from obtaining automatic approval of such adoption, retention, or change in tax year.

Note. If you do not use item P and the corporation wants a fiscal tax year, complete either item Q or R below. Item Q is used to request a fiscal
tax year based on a business purpose and to make a back-up section 444 election. Item R is used to make a regular section 444 election.
Q Business Purpose—To request a fiscal tax year based on a business purpose, check box Q1. See instructions for details including payment
of a user fee. You may also check box Q2 and/or box Q3.
1. Check here © if the fiscal year entered in item F, Part I, is requested under the prior approval provisions of Rev. Proc. 2002-39,
2002-22 I.R.B. 1046. Attach to Form 2553 a statement describing the relevant facts and circumstances and, if applicable, the gross receipts
from sales and services necessary to establish a business purpose. See the instructions for details regarding the gross receipts from sales
and services. If the IRS proposes to disapprove the requested fiscal year, do you want a conference with the IRS National Office?

Yes No
2. Check here © to show that the corporation intends to make a back-up section 444 election in the event the corporation’s business
purpose request is not approved by the IRS. (See instructions for more information.)

3. Check here © to show that the corporation agrees to adopt or change to a tax year ending December 31 if necessary for the IRS
to accept this election for S corporation status in the event (1) the corporation’s business purpose request is not approved and the
corporation makes a back-up section 444 election, but is ultimately not qualified to make a section 444 election, or (2) the corporation’s
business purpose request is not approved and the corporation did not make a back-up section 444 election.

R Section 444 Election—To make a section 444 election, check box R1. You may also check box R2.
1. Check here © to show that the corporation will make, if qualified, a section 444 election to have the fiscal tax year shown in item F,
Part I. To make the election, you must complete Form 8716, Election To Have a Tax Year Other Than a Required Tax Year, and either
attach it to Form 2553 or file it separately.
2. Check here © to show that the corporation agrees to adopt or change to a tax year ending December 31 if necessary for the IRS
to accept this election for S corporation status in the event the corporation is ultimately not qualified to make a section 444 election.

Part III Qualified Subchapter S Trust (QSST) Election Under Section 1361(d)(2)*
Income beneficiary’s name and address Social security number

Trust’s name and address Employer identification number

Date on which stock of the corporation was transferred to the trust (month, day, year) © / /
In order for the trust named above to be a QSST and thus a qualifying shareholder of the S corporation for which this Form 2553 is filed, I
hereby make the election under section 1361(d)(2). Under penalties of perjury, I certify that the trust meets the definitional requirements of
section 1361(d)(3) and that all other information provided in Part III is true, correct, and complete.

Signature of income beneficiary or signature and title of legal representative or other qualified person making the election Date

*Use Part III to make the QSST election only if stock of the corporation has been transferred to the trust on or before the date on which the
corporation makes its election to be an S corporation. The QSST election must be made and filed separately if stock of the corporation is
transferred to the trust after the date on which the corporation makes the S election.

Printed on recycled paper Form 2553 (Rev. 12-2007)