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|   | A. | ____percent      of gross salary per pay period otherwise payable to the Employee during      calendar year ____[may not be current year], not to exceed $________ for      the year [may not exceed 30%]; and |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | B. | ____percent      of any bonus which may otherwise become payable to the Employee in respect      of services rendered during the calendar year ____, not to exceed      $__________ for the year [may not exceed30%]. |
|--------|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | (a) | in      the event that the Employee shall be determined by a court of competent      jurisdiction to be incapable of managing his financial affairs, and if the      Company has actual notice of such determination, payment shall be made to      the Employee’s personal representative(s);and |
|--------|-----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | (b) | in      the event of the Employee’s death, payment of the balance of the      Employee’s Deferred Compensation Account shall be made in a single lump      sum payment (even if the Employee had elected or was receiving installment      payments) thirty (30) days after the death of the Employee to the last      beneficiary designated by the Employee (see Designation of      Beneficiary(ies) attached hereto) for purposes of receiving such payment      in such event in a written notice delivered to the Secretary of the      Company; provided, that if such beneficiary has not survived the Employee,      or no valid beneficiary designation is in effect, payment shall instead be      made to the Employee’s estate. |
|--------|-----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   |   | By: | ____________________________________ |
|--------|--------|-----|--------------------------------------|

|   | Its: | ____________________________________ |
|--------|------|--------------------------------------|

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