This excerpt taken from the CVS 8-K filed Jan 11, 2005.
A. Tax Withholding (check box if applicable)
o In lieu of having the number of Shares underlying the RSUs reduced, I hereby elect to pay to the Company any amount required to be withheld by the Company in connection with the vesting of the RSUs or delivery of Shares pursuant to the Agreement.
If Participant would like to designate a beneficiary to exercise rights under this RSU in the event of Participants death, please complete the designation in the space provided below.
Date: January __, 200__