83 (B) Form
83 (B) Form
83 (B) Form
to Section 83(b) of the Internal Revenue Code of !8", as a#ended, to include in taxpayer$s gross inco#e or alternative #ini#u# taxable inco#e, as applicable, for the current taxable year, the a#ount of any inco#e that #ay be taxable to taxpayer in connection %ith taxpayer$s receipt of the property described belo%& ' The na#e, address, taxpayer identification nu#ber and taxable year of the undersigned are as follo%s& ()*+ ,- T)./)0+R& ()*+ ,- S/,1S+& )33R+SS& I3+(TI-IC)TI,( (,' ,- T)./)0+R& I3+(TI-IC)TI,( (,' ,- S/,1S+& T).):;+ 0+)R& 9' (guyen (guyen (2) 45 Sunny 6ay, /alo )lto, C) !7357 "358958 937 (2) 95 7
The property %ith respect to %hich the election is #ade is described as follo%s& ,555,555 shares of Co##on Stoc< of Startup, Inc', a 3ela%are corporation (the = Company=)'
3' 7'
The date on %hich the property %as transferred is >anuary 4, 95 7' The property is sub?ect to the follo%ing restriction& Repurchase option at original cost in favor of the Co#pany upon ter#ination of taxpayer$s e#ploy#ent or consulting relationship' The nu#ber of shares sub?ect to repurchase declines over a period of @.A years'
4' "'
The fair #ar<et value at the ti#e of transfer, deter#ined %ithout regard to any restriction other than a restriction %hich by its ter#s %ill never lapse, of such property is B5'555 per share' The a#ount (if any) paid for such property is B5'555 per share'
The undersigned has sub#itted a copy of this state#ent to the person for %ho# the services %ere perfor#ed in connection %ith the undersigned$s receipt of the above -described property' The transferee of such property is the person perfor#ing the services in connection %ith the transfer of such property' The unders !ned unders"#nds "h#" "he $%re!% n! e&e'" %n (#) n%" be re*%+ed e,'e-" . "h "he '%nsen" %$ "he C%(( ss %ner/ 3ated& Taxpayer 3ated& Spouse of Taxpayer