Enertopia Corporation: Exhibit 10.2 - Filed by newsfilecorp.com






STOCK OPTION AGREEMENT 

ENERTOPIA CORP. 

THIS AGREEMENT is entered into as of the 1st day of
April, 2014 (the “Date of Grant”) 

BETWEEN: 

ENERTOPIA CORP., a company
incorporated pursuant to the laws of the State of Nevada, of 
Suite 950 1130
West Pender, 
Vancouver, BC V6E 4A4 

(the “Company”) 

AND: 

Kristian Dagsaan 
Suite 608,
1529 Pender Street 
Vancouver British Columbia, V6G 3J3 

(the “Optionee”) 

WHEREAS: 

A.           The Board of Directors of the Company (the “Board”) has
approved and adopted the 2011 Stock Option Plan (the “Plan”), pursuant to which
the Board is authorized to grant to employees and other selected persons stock
options to purchase common shares of the Company (the “Common Stock”); 

B.            The Plan provides for the granting of stock options that
either (i) are intended to qualify as “Incentive Stock Options” within the
meaning of Section 422 of the Internal Revenue Code of 1986, as amended (the
“Code”), or (ii) do not qualify under Section 422 of the Code (“Non-Qualified
Stock Options”); and 

C.             The Board has authorized the grant to the Optionee of
options to purchase a total of 100,000 shares of Common Stock (the
“Options”), which Options are intended to be (select one): 


	[     ] 	Incentive Stock Options; 
	 	 
	[ X ] 	Qualified Stock Options




NOW THEREFORE, the Company agrees to offer to the Optionee the
option to purchase, upon the terms and conditions set forth herein and in the
Plan, 100,000 shares of Common Stock. Capitalized terms not otherwise
defined herein shall have the meanings ascribed thereto in the Plan. 

ITEM 1                 Exercise price. The exercise price of the options shall
be US$0.86 per share. 









 - 2 – 


ITEM 2                 Limitation on the number of shares. If the options granted hereby are incentive stock options, the number of shares which may be acquired upon exercise thereof is subject to the limitations set forth in section 5.1 of the plan. 


ITEM 3                 Vesting schedule. The options shall vest in accordance with exhibit a. 


ITEM 4                 Options not transferable. The options may not be transferred, assigned, pledged or hypothecated in any manner (whether by operation of law or otherwise) other than by will, by applicable laws of descent and distribution or, in the case of a
non-qualified stock option, pursuant to a qualified domestic relations order, and shall not be subject to execution, attachment or similar process; provided, however, that if the options represent a non-qualified stock option, such option is
transferable without payment of consideration to immediate family members of the optionee or to trusts or partnerships established exclusively for the benefit of the optionee and optionee’s immediate family members. Upon any attempt to
transfer, pledge, hypothecate or otherwise dispose of any option or of any right or privilege conferred by the plan contrary to the provisions thereof, or upon the sale, levy or attachment or similar process upon the rights and privileges conferred
by the plan, such option shall thereupon terminate and become null and void. 


ITEM 5                 Investment intent. By accepting the options, the optionee represents and agrees that none of the shares of common stock purchased upon exercise of the options will be distributed in violation of applicable federal and state laws and
regulations.  In addition, the company may require, as a condition of exercising the options, that the optionee execute an undertaking, in such a form as the company shall reasonably specify, that the stock is being purchased only for investment and
without any then-present intention to sell or distribute such shares. 


ITEM 6                 Termination of employment and options. Vested options shall terminate, to the extent not previously exercised, upon the occurrence of the first of the following events: 

	
 	
(A) 		
Expiration. Five (5) years from the date of grant.

	
	 	 	 
	
 	
(B) 		
Termination for cause. The date of the first discovery by the company of any reason for the termination of an optionee’s employment or contractual relationship with the company or any related company for cause (as determined
in the sole discretion of the plan administrator), and, if an optionee’s employment is suspended pending any investigation by the company as to whether the optionee’s employment should be terminated for cause, the optionee’s rights
under this agreement and the plan shall likewise be suspended during the period of any such investigation.

	
	 	 	 
	
 	
(C) 		
Termination due to death or disability. The expiration of one (1) year from the date of the death of the optionee or cessation of an optionee’s employment or contractual relationship by reason of disability (as defined in
section 5.1(g) of the plan). If an optionee’s employment or contractual relationship is terminated by death, any option held by the optionee shall be exercisable only by the person or persons to whom such optionee’s rights under such option shall pass by the optionee’s will or by the laws of descent and distribution.

	













- 3 – 

	
 	
(D) 		
Termination for any other reason. The expiration of ninety (90) days from the date of an optionee’s termination of employment or contractual relationship with the company or any related corporation for any reason whatsoever
other than termination of service as a director, cause, death or disability (as defined in section 5.1(g) of the plan).

	



Each unvested Option granted pursuant hereto shall terminate immediately upon termination of the Optionee’s employment or contractual relationship with the Company for any reason whatsoever, including Disability unless vesting is accelerated
in accordance with Section 5.1(f) of the Plan. 


ITEM 7                 Stock. In the case of any stock split, stock dividend or like change in the nature of shares of stock covered by this agreement, the number of shares and exercise price shall be proportionately adjusted as set forth in section 5.1(m)
of the plan. 


ITEM 8                 Exercise of option.  Options shall be exercisable, in full or in part, at any time after vesting, until termination; provided, however, that any optionee who is subject to the reporting and liability provisions of section 16 of
the securities exchange act of 1934 with respect to the common stock shall be precluded from selling or transferring any common stock or other security underlying an option during the six (6) months immediately following the grant of that
option.  If less than all of the shares included in the vested portion of any option are purchased, the remainder may be purchased at any subsequent time prior to the expiration of the option term.  No portion of any option for less than fifty (50)
shares (as adjusted pursuant to section 5.1(m) of the plan) may be exercised; provided, that if the vested portion of any option is less than fifty (50) shares, it may be exercised with respect to all shares for which it is vested. Only whole shares
may be issued pursuant to an option, and to the extent that an option covers less than one (1) share, it is unexercisable. 


Each exercise of the Option shall be by means of delivery of a notice of election to exercise (which may be in the form attached hereto as Exhibit B) to the President of the Company at its principal executive office, specifying the number of
shares of Common Stock to be purchased and accompanied by payment in cash by certified check or cashier’s check in the amount of the full exercise price for the Common Stock to be purchased. In addition to payment in cash by certified check or
cashier’s check, an Optionee or transferee of an Option may pay for all or any portion of the aggregate exercise price by complying with one or more of the following alternatives: 

	
 	
(A) 		
By delivering to the company shares of common stock previously held by such person, duly endorsed for transfer to the company, or by the company withholding shares of common stock otherwise deliverable pursuant to exercise of the
option, which shares of common stock received or withheld shall have a fair market value at the date of exercise (as determined by the plan administrator) equal to the aggregate purchase price to be paid by the optionee upon such exercise; or

	













- 4 – 

	
 	
(B) 		
By complying with any other payment mechanism approved by the plan administrator at the time of exercise.

	



It is a condition precedent to the issuance of shares of Common Stock that the Optionee execute and/or deliver to the Company all documents and withholding taxes required in accordance with Section 5.1 of the Plan. 


ITEM 9                 Holding period for incentive stock options. In order to obtain the tax treatment provided for incentive stock options by section 422 of the code, the shares of common stock received upon exercising any incentive stock options received
pursuant to this agreement must be sold, if at all, after a date which is later of two (2) years from the date of this agreement is entered into or one (1) year from the date upon which the options are exercised. The optionee agrees to report sales
of shares prior to the above determined date to the company within one (1) business day after such sale is concluded.  The optionee also agrees to pay to the company, within five (5) business days after such sale is concluded, the amount necessary
for the company to satisfy its withholding requirement required by the code in the manner specified in section 5.1(l) of the plan. Nothing in this section 9 is intended as a representation that common stock may be sold without registration under
state and federal securities laws or an exemption therefrom or that such registration or exemption will be available at any specified time. 


ITEM 10                 Resale restrictions may apply. Any resale of the shares of common stock received upon exercising any options will be subject to resale restrictions contained in the securities legislation applicable to the optionee. The optionee
acknowledges and agrees that the optionee is solely responsible (and the company is not in any way responsible) for compliance with applicable resale restrictions. 


ITEM 11                 Subject to 2011 stock option plan.  The terms of the options are subject to the provisions of the plan, as the same may from time to time be amended, and any inconsistencies between this agreement and the plan, as the same may be from
time to time amended, shall be governed by the provisions of the plan, a copy of which has been delivered to the optionee, and which is available for inspection at the principal offices of the company. 


ITEM 12                 Professional advice. The acceptance of the options and the sale of common stock issued pursuant to the exercise of options may have consequences under federal and state tax and securities laws which may vary depending upon the
individual circumstances of the optionee. Accordingly, the optionee acknowledges that he or she has been advised to consult his or her personal legal and tax advisor in connection with this agreement and his or her dealings with respect to options.
Without limiting other matters to be considered with the assistance of the optionee’s professional advisors, the optionee should consider: (a) whether upon the exercise of options, the optionee will file an election with the internal revenue
service pursuant to section 83(b) of the code and the implications of alternative minimum tax pursuant to the code; (b) the merits and risks of an investment in the underlying shares of common stock; and (c) any resale restrictions that might apply
under applicable securities laws. 


ITEM 13                 No employment relationship. Whether or not any options are to be granted under this plan shall be exclusively within the discretion of the plan administrator, and nothing contained in this plan shall be construed as giving any person
any right to participate under this plan. The grant of an option shall in no way constitute any
form of agreement or understanding binding on the company or any related
company, express or implied, that the company or any related company will employ
or contract with an optionee, for any length of time, nor shall it interfere in
any way with the company’s or, where applicable, a related company’s right to
terminate optionee’s employment at any time, which right is hereby reserved. 






- 5 – 

ITEM 14                 Entire agreement. This agreement is the only
agreement between the optionee and the company with respect to the options, and
this agreement and the plan supersede all prior and contemporaneous oral and
written statements and representations and contain the entire agreement between
the parties with respect to the options. 

ITEM 15                Notices. Any notice required or permitted to be
made or given hereunder shall be mailed or delivered personally to the addresses
set forth below, or as changed from time to time by written notice to the other:


The Company: 

Enertopia Corp.
Suite 950 1130 West
Pender Street 
Vancouver, BC V6E 4A4 
Attention: President 

With a copy to: 

W.L. Macdonald Law Corporation 
400
– 570 Granville Street 
Vancouver, British Columbia V6C 3P1 
Attention:
William Macdonald 

The Optionee: 

Kristian Dagsaan 
Suite 608, 1529
Pender Street 
Vancouver British Columbia, V6G 3J3 

 

ENERTOPIA CORP. 

Per:
___________________________
       
Authorized Signatory 




- 6 – 

EXHIBIT A 

	TERMS OF THE OPTION 
	  	  	  
	Name of the Optionee: 	   Kristian Dagsaan 
	 	 
	Date of Grant: 	   April 1, 2014 
	 	 
	Designation: 	   Qualified Stock Options 
	 	 
	1. Number of Options granted: 		   100,000 stock options 
	 	 	 
	2. Purchase Price: 		   $0.86 share 
	 	 	 
	3. Vesting Date: 		   100,000 options on April 1, 2014;
    
	 	 	 
	4. Expiration Date: 		   April 1, 2019







- 7 – 

EXHIBIT B 

To: 

Enertopia Corp. 
Suite 950
1130 West Pender 
Vancouver, BC V6E 4A4 
Attention: President 

Notice of Election to Exercise 

This Notice of Election to Exercise shall constitute proper
notice pursuant to Section 5.1(h) of Enertopia Corp.’s (the “Company”) 2011
Stock Option Plan (the “Plan”) and Section 8 of that certain Stock Option
Agreement (the “Agreement”) dated as of the 
_______day of
__________________, 20___, between the Company and the undersigned.

The undersigned hereby elects to exercise Optionee’s option to
purchase __________________shares of the common stock of the Company at a price
of US$0.86 per share, for aggregate consideration of US$__________, on the terms
and conditions set forth in the Agreement and the Plan. Such aggregate
consideration, in the form specified in Section 8 of the Agreement, accompanies
this notice. 

The Optionee hereby directs the Company to issue, register and
deliver the certificates representing the shares as follows: 

	Registration Information: 	 	Delivery Instructions: 
	 	 	 
	Name to appear on certificates 	 	Name 
	 	 	 
	Address 	 	Address 
	  	 	  
	 	 	 
	  	 	Telephone Number 






- 8 – 

DATED at ____________________________________, the _______day
of ________________________, 20___. 

______________________________________
(Name of Optionee –
Please type or print) 

______________________________________
(Signature and, if
applicable, Office) 

______________________________________
(Address of
Optionee)

 ______________________________________
(City, State,
and Zip Code of Optionee) 

 



STOCK OPTION AGREEMENT 

ENERTOPIA CORP. 

THIS AGREEMENT is entered into as of the 1st day of
April, 2014 (the “Date of Grant”) 

BETWEEN: 

ENERTOPIA CORP., a company
incorporated pursuant to the laws of the State of Nevada, of 
Suite 950 1130
West Pender, 
Vancouver, BC V6E 4A4 

(the “Company”) 

AND: 

Ken Faulkner 
4172
Gallagher’s Grove 
Kelowna, B.C. V1W 3Z9 

(the “Optionee”) 

WHEREAS: 

A.                 The Board of Directors of the Company (the “Board”) has
approved and adopted the 2011 Stock Option Plan (the “Plan”), pursuant to which
the Board is authorized to grant to employees and other selected persons stock
options to purchase common shares of the Company (the “Common Stock”);

B.                 The
Plan provides for the granting of stock options that either (i) are intended to
qualify as “Incentive Stock Options” within the meaning of Section 422 of the
Internal Revenue Code of 1986, as amended (the “Code”), or (ii) do not qualify
under Section 422 of the Code (“Non-Qualified Stock Options”); and 

C.                 The Board
has authorized the grant to the Optionee of options to purchase a total of
100,000 shares of Common Stock (the “Options”), which Options are
intended to be (select one): 


	[   ] 	Incentive Stock Options; 
	[ X ] 	Qualified Stock Options




NOW THEREFORE, the Company agrees to offer to the Optionee the
option to purchase, upon the terms and conditions set forth herein and in the
Plan, 100,000 shares of Common Stock. Capitalized terms not otherwise
defined herein shall have the meanings ascribed thereto in the Plan. 

ITEM 1                 Exercise price. The exercise price of the options shall
be US$0.86 per share. 









 - 2 – 


ITEM 2                 Limitation on the number of shares. If the options granted hereby are incentive stock options, the number of shares which may be acquired upon exercise thereof is subject to the limitations set forth in section 5.1 of the plan. 


ITEM 3                 Vesting schedule. The options shall vest in accordance with exhibit a. 


ITEM 4                 Options not transferable. The options may not be transferred, assigned, pledged or hypothecated in any manner (whether by operation of law or otherwise) other than by will, by applicable laws of descent and distribution or, in the case of a
non-qualified stock option, pursuant to a qualified domestic relations order, and shall not be subject to execution, attachment or similar process; provided, however, that if the options represent a non-qualified stock option, such option is
transferable without payment of consideration to immediate family members of the optionee or to trusts or partnerships established exclusively for the benefit of the optionee and optionee’s immediate family members. Upon any attempt to
transfer, pledge, hypothecate or otherwise dispose of any option or of any right or privilege conferred by the plan contrary to the provisions thereof, or upon the sale, levy or attachment or similar process upon the rights and privileges conferred
by the plan, such option shall thereupon terminate and become null and void. 


ITEM 5                 Investment intent. By accepting the options, the optionee represents and agrees that none of the shares of common stock purchased upon exercise of the options will be distributed in violation of applicable federal and state laws and
regulations.  In addition, the company may require, as a condition of exercising the options, that the optionee execute an undertaking, in such a form as the company shall reasonably specify, that the stock is being purchased only for investment and
without any then-present intention to sell or distribute such shares. 


ITEM 6                 Termination of employment and options. Vested options shall terminate, to the extent not previously exercised, upon the occurrence of the first of the following events: 

	
 	
(A) 		
Expiration. Five (5) years from the date of grant.

	
	 	 	 
	
 	
(B) 		
Termination for cause. The date of the first discovery by the company of any reason for the termination of an optionee’s employment or contractual relationship with the company or any related company for cause (as determined
in the sole discretion of the plan administrator), and, if an optionee’s employment is suspended pending any investigation by the company as to whether the optionee’s employment should be terminated for cause, the optionee’s rights
under this agreement and the plan shall likewise be suspended during the period of any such investigation.

	
	 	 	 
	
 	
(C) 		
Termination due to death or disability. The expiration of one (1) year from the date of the death of the optionee or cessation of an optionee’s employment or contractual relationship by reason of disability (as defined in
section 5.1(g) of the plan). If an optionee’s employment or contractual relationship is terminated by death, any option held by the optionee shall be exercisable only by the person or persons to whom such optionee’s rights under such option shall pass by the optionee’s will or by the laws of descent and distribution.

	













- 3 – 

	
 	
(D) 		
Termination for any other reason. The expiration of ninety (90) days from the date of an optionee’s termination of employment or contractual relationship with the company or any related corporation for any reason whatsoever
other than termination of service as a director, cause, death or disability (as defined in section 5.1(g) of the plan).

	



Each unvested Option granted pursuant hereto shall terminate immediately upon termination of the Optionee’s employment or contractual relationship with the Company for any reason whatsoever, including Disability unless vesting is accelerated
in accordance with Section 5.1(f) of the Plan. 


ITEM 7                 Stock. In the case of any stock split, stock dividend or like change in the nature of shares of stock covered by this agreement, the number of shares and exercise price shall be proportionately adjusted as set forth in section 5.1(m)
of the plan. 


ITEM 8                 Exercise of option. Options shall be exercisable, in full or in part, at any time after vesting, until termination; provided, however, that any optionee who is subject to the reporting and liability provisions of section 16 of
the securities exchange act of 1934 with respect to the common stock shall be precluded from selling or transferring any common stock or other security underlying an option during the six (6) months immediately following the grant of that
option.  If less than all of the shares included in the vested portion of any option are purchased, the remainder may be purchased at any subsequent time prior to the expiration of the option term.  No portion of any option for less than fifty (50)
shares (as adjusted pursuant to section 5.1(m) of the plan) may be exercised; provided, that if the vested portion of any option is less than fifty (50) shares, it may be exercised with respect to all shares for which it is vested. Only whole shares
may be issued pursuant to an option, and to the extent that an option covers less than one (1) share, it is unexercisable. 


Each exercise of the Option shall be by means of delivery of a notice of election to exercise (which may be in the form attached hereto as Exhibit B) to the President of the Company at its principal executive office, specifying the number of
shares of Common Stock to be purchased and accompanied by payment in cash by certified check or cashier’s check in the amount of the full exercise price for the Common Stock to be purchased. In addition to payment in cash by certified check or
cashier’s check, an Optionee or transferee of an Option may pay for all or any portion of the aggregate exercise price by complying with one or more of the following alternatives: 

	
 	
(A) 		
By delivering to the company shares of common stock previously held by such person, duly endorsed for transfer to the company, or by the company withholding shares of common stock otherwise deliverable pursuant to exercise of the
option, which shares of common stock received or withheld shall have a fair market value at the date of exercise (as determined by the plan administrator) equal to the aggregate purchase price to be paid by the optionee upon such exercise; or

	













- 4 – 

	
 	
(B) 		
By complying with any other payment mechanism approved by the plan administrator at the time of exercise.

	



It is a condition precedent to the issuance of shares of Common Stock that the Optionee execute and/or deliver to the Company all documents and withholding taxes required in accordance with Section 5.1 of the Plan. 


ITEM 9                 Holding period for incentive stock options. In order to obtain the tax treatment provided for incentive stock options by section 422 of the code, the shares of common stock received upon exercising any incentive stock options received
pursuant to this agreement must be sold, if at all, after a date which is later of two (2) years from the date of this agreement is entered into or one (1) year from the date upon which the options are exercised. The optionee agrees to report sales
of shares prior to the above determined date to the company within one (1) business day after such sale is concluded.  The optionee also agrees to pay to the company, within five (5) business days after such sale is concluded, the amount necessary
for the company to satisfy its withholding requirement required by the code in the manner specified in section 5.1(l) of the plan. Nothing in this section 9 is intended as a representation that common stock may be sold without registration under
state and federal securities laws or an exemption therefrom or that such registration or exemption will be available at any specified time. 


ITEM 10                 Resale restrictions may apply. Any resale of the shares of common stock received upon exercising any options will be subject to resale restrictions contained in the securities legislation applicable to the optionee. The optionee
acknowledges and agrees that the optionee is solely responsible (and the company is not in any way responsible) for compliance with applicable resale restrictions. 


ITEM 11                 Subject to 2011 stock option plan.  The terms of the options are subject to the provisions of the plan, as the same may from time to time be amended, and any inconsistencies between this agreement and the plan, as the same may be from
time to time amended, shall be governed by the provisions of the plan, a copy of which has been delivered to the optionee, and which is available for inspection at the principal offices of the company. 


ITEM 12                 Professional advice. The acceptance of the options and the sale of common stock issued pursuant to the exercise of options may have consequences under federal and state tax and securities laws which may vary depending upon the
individual circumstances of the optionee. Accordingly, the optionee acknowledges that he or she has been advised to consult his or her personal legal and tax advisor in connection with this agreement and his or her dealings with respect to options.
Without limiting other matters to be considered with the assistance of the optionee’s professional advisors, the optionee should consider: (a) whether upon the exercise of options, the optionee will file an election with the internal revenue
service pursuant to section 83(b) of the code and the implications of alternative minimum tax pursuant to the code; (b) the merits and risks of an investment in the underlying shares of common stock; and (c) any resale restrictions that might apply
under applicable securities laws. 


ITEM 13                 No employment relationship. Whether or not any options are to be granted under this plan shall be exclusively within the discretion of the plan administrator, and nothing contained in this plan shall be construed as giving any person
any right to participate under this plan. The grant of an option shall in no way constitute any
form of agreement or understanding binding on the company or any related
company, express or implied, that the company or any related company will employ
or contract with an optionee, for any length of time, nor shall it interfere in
any way with the company’s or, where applicable, a related company’s right to
terminate optionee’s employment at any time, which right is hereby reserved. 






- 5 – 

ITEM 14                 Entire agreement. This agreement is the only
agreement between the optionee and the company with respect to the options, and
this agreement and the plan supersede all prior and contemporaneous oral and
written statements and representations and contain the entire agreement between
the parties with respect to the options. 

ITEM 15                 Notices. Any notice required or permitted to be
made or given hereunder shall be mailed or delivered personally to the addresses
set forth below, or as changed from time to time by written notice to the other:


The Company: 

Enertopia Corp. 

Suite 950 1130 West Pender Street

Vancouver, BC V6E 4A4 
Attention: President 

With a copy to: 

W.L. Macdonald Law Corporation 
400
– 570 Granville Street 
Vancouver, British Columbia V6C 3P1 
Attention:
William Macdonald 

The Optionee: 

Ken Faulkner 
4172
Gallagher’s Grove 
Kelowna, B.C. V1W 3Z9 

 

ENERTOPIA CORP. 

Per:
______________________
       Authorized
Signatory 




- 6 – 

EXHIBIT A 

TERMS OF THE OPTION 

	Name of the Optionee: 	Ken Faulkner 
	 	 
	Date of Grant: 	April 1, 2014 
	 	 
	Designation: 	Qualified Stock Options 
	 	 
	1. Number of Options granted: 		100,000 stock options 
	 	 	 
	2. Purchase Price: 		$0.86 share 
	 	 	 
	3. Vesting Date: 		100,000 options on April 1, 2014; 
	 	 	 
	4. Expiration Date: 		April 1, 2019 











 - 7 – 


EXHIBIT B 


To: 


Enertopia Corp. 

Suite 950 1130 West Pender

Vancouver, BC V6E 4A4 

Attention: President 


Notice of Election to Exercise 


This Notice of Election to Exercise shall constitute proper notice pursuant to Section 5.1(h) of Enertopia Corp.’s (the “Company”) 2011 Stock Option Plan (the “Plan”) and Section 8 of that certain Stock Option Agreement
(the “Agreement”) dated as of the _______day of __________________, 20___, between the Company and the undersigned. 


The undersigned hereby elects to exercise Optionee’s option to purchase __________________shares of the common stock of the Company at a price of US$0.86 per share, for aggregate consideration of US$__________, on the
terms and conditions set forth in the Agreement and the Plan. Such aggregate consideration, in the form specified in Section 8 of the Agreement, accompanies this notice. 


The Optionee hereby directs the Company to issue, register and deliver the certificates representing the shares as follows: 


	Registration Information: 	 	Delivery Instructions: 
	 	 	 
	Name to appear on certificates 	 	Name 
	 	 	 
	Address 	 	Address 
	  	 	  
	 	 	 
	  	 	Telephone Number 







- 8 – 

DATED at ____________________________________, the _______day
of ________________________, 20___. 

______________________________________
(Name of Optionee –
Please type or print) 

______________________________________
(Signature and, if
applicable, Office) 

______________________________________
(Address of
Optionee)

 ______________________________________
(City, State,
and Zip Code of Optionee)