GVHR » Topics » NOTICE OF WITHHOLDING ELECTION GEVITY HR, INC. 1997 STOCK INCENTIVE PLAN

This excerpt taken from the GVHR 8-K filed Feb 15, 2005.

NOTICE OF WITHHOLDING ELECTION
GEVITY HR, INC. 1997 STOCK INCENTIVE PLAN

TO:
Gevity HR, Inc.
Attn: Corporate Secretary

FROM:

RE: Withholding Election

        This election relates to the Option identified in Paragraph 3 below. I hereby certify that:

  (1) My correct name and social security number and my current address are set forth at the end of this document.

  (2) I am (check one, whichever is applicable).

  [ ] the original recipient of the Option.

  [ ] the legal representative of the estate of the original recipient of the Option.

  [ ] a legatee of the original recipient of the Option.

  [ ] the legal guardian of the original recipient of the Option.

  (3) The Option pursuant to which this election relates was issued under the Gevity HR, Inc. 1997 Stock Incentive Plan in the name of _____________________ for the purchase of a total of __________ shares of Common Stock. This election relates to _____________ shares of Common Stock issuable upon exercise of the Option (the “Stock”), provided that the numbers set forth above shall be deemed changed as appropriate to reflect the applicable Plan provisions.

  (4) In connection with any exercise of the Option with respect to Stock, I hereby elect:

  [ ] to have certain shares otherwise issuable pursuant to the exercise withheld by the Company for the purpose of having the value of the shares applied to pay federal, state and local, if any, taxes arising from the exercise.

  [ ] to tender shares held by me for a period of at least six (6) months prior to the exercise of the Option for the purpose of having the value of the shares applied to pay such taxes.

  The shares to be withheld, or tendered, as the case may be, shall have, as of the Tax Date applicable to the exercise, a fair market value equal to the minimum statutory tax withholding requirement under federal, state and local law in connection with the exercise.

  (5) This Withholding Election is made no later than the Tax Date and is otherwise timely made pursuant to the Plan.

  (6) I understand that this Withholding Election may not be revised, amended or revoked by me.

  (7) The Plan has been made available to me by the Company, I have read and understand the Plan and I have no reason to believe that any of the conditions therein to the making of this Withholding Election have not been met. Capitalized terms used in this Notice of Withholding Election shall have the meanings given to them in the Plan.

  (8)         Capitalized terms used in this Notice of Withholding Election without definition shall have the meanings given to them in the Plan.

Dated: ____________________

____________________________________
Signature

____________________________________
Name (printed)

___________________________________
Street Address

____________________________________
City, State, Zip Code

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