S CORPORATION - SHAREHOLDER'S<br> CONSENT TO INITIAL ELECTION

The undersigned, being a shareholder of ______________________, a ____________ 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:  ________________, ________________.  The corporation's tax-payer identification number is:  ______________.

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

Name and Address             	Taxpayer Identification No.

______________________    	______________________ 

______________________ 

______________________ 

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

_____                   	___________________

_____   			___________________

Dated ____________________ 

___________________________