× This is not the latest version. This is version 1 from 7 years ago. View latest or show what's different from the latest version.

Acknowledgement and Statement of Decision Regarding Section 83(b) Election - Version 1

Document may be included as an exhibit to the Common Stock Purchase Agreement (with Vesting) and the Restricted Stock Purchase Agreement

EXHIBIT B

ACKNOWLEDGMENT AND STATEMENT OF DECISION 
REGARDING SECTION 83(b) ELECTION

The undersigned has entered into a stock purchase agreement with [Company Name], a Delawarecorporation (the “Company”), pursuant to which the undersigned is purchasing # Purchased shares of Common Stock of the Company (the “Shares”). In connection with the purchase of the Shares, the undersigned hereby represents as follows:

1. The undersigned has carefully reviewed the stock purchase agreement pursuant to which the undersigned is purchasing the Shares.

2. The undersigned either [check and complete as applicable]:

(a) ___ has consulted, and has been fully advised by, the undersigned’s own tax advisor, Tax Advisor, whose business address is Tax Advisor Business Address, regarding the federal, state and local tax consequences of purchasing the Shares, and particularly regarding the advisability of making elections pursuant to Section 83(b) of the Internal Revenue Code of 1986, as amended (the “Code”) and pursuant to the corresponding provisions, if any, of applicable state law; or

(b) ___has knowingly chosen not to consult such a tax advisor.

3. The undersigned hereby states that the undersigned has decided [check as applicable]:

(a) ___ to make an election pursuant to Section 83(b) of the Code, and is submitting to the Company, together with the undersigned’s executed Common Stock Purchase Agreement, an executed form entitled “Election Under Section 83(b) of the Internal Revenue Code of 1986;” or

(b) ___ not to make an election pursuant to Section 83(b) of the Code.

4. Neither the Company nor any subsidiary or representative of the Company has made any warranty or representation to the undersigned with respect to the tax consequences of the undersigned’s purchase of the Shares or of the making or failure to make an election pursuant to Section 83(b) of the Code or the corresponding provisions, if any, of applicable state law.

Dated: Exhibit B Signed Date

PURCHASER: 

[PURCHASER NAME] 

By: Purchaser Signature
(Signature) 

Address: 
Purchaser Street 
Purchaser CityPurchaser State Purchaser Zip 

Spouse of Purchaser (if applicable)
Spouse of Purchaser (if applicable) 

Orrick

27 513,672 0

Public Document

Number of times Signed
3
Number of Saves
24
Number of Downloads
1.9k
Number of Views
10.3k

This is version 1, from 7 years ago.

Suggest changes by making a copy of this document. Learn more.

Create Branch

Love this document

They love this document: