Instructions for Completing IRS Section 83(b) Form

To make an 83(b) election, you must complete the IRS Section 83(b) Form and mail it to the IRS within 30 days of your exercise date. You will also need to return a copy of the completed form to your employer, and attach a copy of the completed and filed form to your income tax return when you file your income taxes for the year in which the election is made.

• Heading: Write your name, address and the date at the top of the form. Below “Department of the Treasury,” address the form to the IRS Service Center where you file your taxes. (See addresses here)

• Number 1: Write your name, address, and Social Security number next to the corresponding field.

• Number 2: Write the number of shares and a description of the shares of stock you received for which you are making the election under Section 83(b).

• Number 3: Write the date and calendar year in which you exercised your stock options.

• Number 4: Describe the restrictions to which your awards are subject. You can find this information in your Award agreement. If you have any questions about the wording in your Award agreement, or about your restriction, please contact the Plan Administrator at your employer.

• Number 5: Record the fair market value (FMV) of the shares at the time you exercised. FMW will be the exercise price times the number of shares.

• Number 6: Write the total amount you paid for your shares. This will be the grant price times the number of stock options exercised. If you did not pay anything for your shares, state that no amount was paid for the shares.

• Number 7: Nothing needs to be written here.

Once you have completed the form, sign it and mail a copy to your IRS Service Center and to your employer. Certified mail is recommended. Be sure to retain a copy for your taxes.