Date:

Via Certified Mail - Return Receipt Requested

Department of the Treasury

Internal Revenue Service

City, State, Zip of the IRS office you’re supposed to mail to

Re: Section 83(b) Election

To whom it may concern,

Enclosed, please find two copies of the Section 83(b) election form for filing on behalf of the following undersigned taxpayer:

Name: ____________

SSN: --___

Address: ____________

Please acknowledge receipt of this filing by signing or stamping and dating the enclosed extra copy and returning it to the undersigned at the address set forth above. Thank you.

Sincerely,

Signature

Your name