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The undersigned, being a shareholder of __________(1)____________, a _____(2)_______ corporation, hereby consents to the election of that corporation, made on Internal Revenue Service Form 2553 to which this statement is attached, to be treated as a small business corporation under Section 1362(a) of the Internal Revenue Code of 1954.

The name and address of the corporation are: _______(3)_________, ________(4)________. The corporation's tax-payer identification number is: ______(5)________.

The undersigned shareholder's name and address and tax-payer identification number are as follows:

Name and Address Taxpayer Identification No.

__________(6)____________ ___________(9)___________

__________(7)____________

__________(8)____________

The number of shares owned by the undersigned shareholder, and the date or dates when the undersigned shareholder acquired those shares, are as follows:

Number of Shares Date(s) Acquired

__(10)___ _________(11)__________

__(12)___ _________(13)__________

Dated ______(14)______________

____________(15)_______________

The information in this document is designed to provide an outline that you can follow when formulating business or personal plans. Due to the variances of many local, city, county and state laws, we recommend that you seek professional legal counseling before entering into any contract or agreement.