Internal Revenue Service

__________(1)____________

REVOCATION OF ELECTION UNDER

INTERNAL REVENUE CODE SECTION 1362

Notice is hereby given, pursuant to Section 1362 of the Internal Revenue Code, that ___________(2)_____________, a ______(3)_______ corporation with offices at ______(4)______, hereby revokes its S corporation election, filed with you on _______(5)_________, 19__(6)_. The first taxable year for which this revocation is intended to be effective is the taxable year commencing _______(7)__________, 19_(8)_.

Dated ___________(9)______________, 19_(10)_.

____________(11)_______________

BY:____________(12)____________ as

President of the corporation

SHAREHOLDERS' CONSENT TO REVOCATION OF ELECTION

We, the undersigned, being more than one-half of the shareholders of __________(13)________ at the beginning of the day on which the revocation of S Corporation election to which this consent is attached was filed with the District Director of Internal Revenue at ________(14)___________, hereby consent to such revocation.

Dated _________(15)___________, 19_(16)_.

Number of

Name and Address Shares Owned Signature

________(17)_________ ____(18)____ _____(19)_____

________(20)_________ ____(21)____ _____(22)_____

________(23)_________ ____(24)____ _____(25)______

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