Document:

WELLS FARGO & COMPANY 8-K

Exhibit 4.1

 

[Face of Note]

 

Unless this certificate
is presented by an authorized representative of The Depository Trust Company, a New York corporation (“DTC”),
to the Company or its agent for registration of transfer, exchange or payment, and any certificate issued is registered in the
name of Cede & Co. or in such other name as requested by an authorized representative of DTC (and any payment is made to Cede
& Co. or such other entity as is requested by an authorized representative of DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF
FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL inasmuch as the registered owner hereof, Cede & Co., has an interest
herein.

 

	CUSIP NO. 95001HFE6	FACE AMOUNT:
    $___________

REGISTERED NO. __

 

WELLS FARGO FINANCE LLC

 

MEDIUM-TERM NOTE, SERIES A

 

Fully and Unconditionally Guaranteed
by Wells Fargo & Company

 

Principal at Risk Securities Linked
to an International Equity Index Basket

 

WELLS FARGO FINANCE
LLC, a limited liability company duly organized and existing under the laws of the State of Delaware (hereinafter called the “Company,”
which term includes any successor corporation under and as defined in the Indenture hereinafter referred to), for value received,
hereby promises to pay to CEDE & Co., or registered assigns, an amount equal to the Cash Settlement Amount (as defined
below), in such coin or currency of the United States of America as at the time of payment is legal tender for payment of public
and private debts, on the Stated Maturity Date. The “Stated Maturity Date” shall be August 30, 2021. If the
Determination Date (as defined below) is postponed for any Basket Underlier (as defined below), the Stated Maturity Date will be
postponed to the second Business Day (as defined below) after the last Determination Date as postponed. This Security shall not
bear any interest.

 

Any payments on this
Security at Maturity will be made against presentation of this Security at the office or agency of the Company maintained for that
purpose in the City of Minneapolis, Minnesota and at any other office or agency maintained by the Company for such purpose.

 

“Face Amount”
shall mean, when used with respect to this Security, the amount set forth on the face of this Security as its “Face Amount.”

 

     

     

    

 

Determination of Cash Settlement
Amount and Certain Definitions

 

The “Cash
Settlement Amount” of this Security will equal:

 

		●	if the Final Basket Level is greater than or equal to the Cap Level, the Maximum Settlement Amount;

 

		●	if the Final Basket Level is greater than the Initial Basket Level but less than the Cap Level,
the sum of (i) the Face Amount plus (ii) the product of (a) the Face Amount times (b) the Upside Participation
Rate times (c) the Basket Return;

 

		●	if the Final Basket Level is equal to or less than the Initial Basket Level, the sum of (i) the
Face Amount plus (ii) the product of (a) the Basket Return times (c) the Face Amount.

 

All calculations with respect to the Cash
Settlement Amount will be rounded to the nearest one hundred-thousandth, with five one-millionths rounded upward (e.g., 0.000005
would be rounded to 0.00001); and the Cash Settlement Amount will be rounded to the nearest cent, with one-half cent rounded upward.

 

The “Basket”
shall mean a basket comprised of the following Basket Underliers, with the “Weight” of each Basket Underlier
noted parenthetically: the EURO STOXX 50® Index (36%); the TOPIX® Index (27%); the FTSE®
100 Index (19%); the Swiss Market Index (SMI®) (10%); and the S&P/ASX 200 Index (8%).

 

“Basket Underlier”
shall mean each of the EURO STOXX 50® Index; the TOPIX® Index; the FTSE® 100 Index;
the Swiss Market Index (SMI®); and the S&P/ASX 200 Index.

 

The “Initial
Weighted Value” of each Basket Underlier shall equal the Weight of such Basket Underlier times the Initial Basket Level
of 100, as follows: the EURO STOXX 50® Index (36.00); the TOPIX® Index (27.00); the FTSE®
100 Index (19.00); the Swiss Market Index (SMI®) (10.00); and the S&P/ASX 200 Index (8.00).

 

The “Trade
Date” shall mean February 26, 2020.

 

The “Initial
Basket Level” is 100.

 

The “Final
Basket Level” will be the sum of the products, calculated for each Basket Underlier, of: (i) the Final Basket Underlier
Level for that Basket Underlier divided by the Initial Basket Underlier Level for that Basket Underlier times (ii) the Initial
Weighted Value of that Basket Underlier.

 

The “Initial
Basket Underlier Level” with respect to each Basket Underlier is the Closing Level of that Basket Underlier on the Trade
Date. The Initial Basket Underlier Levels of the Basket Underliers are as follows: the EURO STOXX 50® Index (3,577.68);
the TOPIX® Index (1,606.17); the FTSE® 100 Index (7,042.47); the Swiss Market Index (SMI®)
(10,512.15); and the S&P/ASX 200 Index (6,708.103).

 

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The “Final
Basket Underlier Level” with respect to each Basket Underlier will be the Closing Level of that Basket Underlier on the
Determination Date.

 

The “Closing
Level” of a Basket Underlier on any Trading Day means the official closing level of that Basket Underlier reported by
the sponsor or publisher of a Basket Underlier (the “Basket Underlier Sponsor”) on such Trading Day, as obtained
by the Calculation Agent on such Trading Day from the licensed third-party market data vendor contracted by the Calculation Agent
at such time; in particular, taking into account the decimal precision and/or rounding convention employed by such licensed third-party
market data vendor on such date, subject to the provisions set forth below under “Discontinuance of a Basket Underlier”,
“Adjustments to a Basket Underlier” and “Market Disruption Events.”

 

The “Basket
Return” will be the quotient of (i) the Final Basket Level minus the Initial Basket Level divided by (ii) the
Initial Basket Level, expressed as a percentage.

 

The “Cap Level”
is 107.40, which is equal to 107.40% of the Initial Basket Level.

 

The “Maximum
Settlement Amount” is 129.60% of the Face Amount of this Security.

 

The “Upside
Participation Rate” is 4.0.

 

“Business
Day” shall mean a day, other than a Saturday or Sunday, that is neither a legal holiday nor a day on which banking institutions
are authorized or required by law or regulation to close in New York, New York.

 

A “Trading
Day” with respect to the TOPIX® Index, the FTSE® 100 Index, the Swiss Market Index
(SMI®) and the S&P/ASX 200 Index means a day, as determined by the Calculation Agent, on which (i) the Relevant
Stock Exchanges with respect to each security underlying such Basket Underlier are scheduled to be open for trading for their respective
regular trading sessions and (ii) each Related Futures or Options Exchange with respect to such Basket Underlier is scheduled to
be open for trading for its regular trading session.

 

A “Trading
Day” with respect to the EURO STOXX 50® Index means a day, as determined by the Calculation Agent, on
which (i) the relevant Basket Underlier Sponsor is scheduled to publish the level of such Basket Underlier and (ii) each Related
Futures or Options Exchange with respect to such Basket Underlier is scheduled to be open for trading for its regular trading session.

 

The “Related
Futures or Options Exchange” for a Basket Underlier means an exchange or quotation system where trading has a material
effect (as determined by the Calculation Agent) on the overall market for futures or options contracts relating to such Basket
Underlier.

 

The “Relevant
Stock Exchange” for any security underlying a Basket Underlier means the primary exchange or quotation system on which
such security is traded, as determined by the Calculation Agent.

 

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The “Determination
Date” shall be August 26, 2021. If the originally scheduled Determination Date is not a Trading Day with respect to any
Basket Underlier, the Determination Date for each Basket Underlier will be postponed to the next succeeding day that is a Trading
Day with respect to each Basket Underlier. The Determination Date for a Basket Underlier is also subject to postponement due to
the occurrence of a Market Disruption Event (as defined below) with respect to such Basket Underlier. See “–Market
Disruption Events.”

 

“Calculation
Agent Agreement” shall mean the Calculation Agent Agreement dated as of May 18, 2018 between the Company and the Calculation
Agent, as amended from time to time.

 

“Calculation
Agent” shall mean the Person that has entered into the Calculation Agent Agreement with the Company providing for, among
other things, the determination of the Final Basket Level and the Cash Settlement Amount, which term shall, unless the context
otherwise requires, include its successors under such Calculation Agent Agreement. The initial Calculation Agent shall be Wells
Fargo Securities, LLC. Pursuant to the Calculation Agent Agreement, the Company may appoint a different Calculation Agent from
time to time after the initial issuance of this Security without the consent of the Holder of this Security and without notifying
the Holder of this Security.

 

Discontinuance Of A Basket Underlier

 

If a Basket Underlier
Sponsor discontinues publication of a Basket Underlier, and such Basket Underlier Sponsor or another entity publishes a successor
or substitute equity index that the Calculation Agent determines, in its sole discretion, to be comparable to such Basket Underlier
(a “Successor Basket Underlier”), then, upon the Calculation Agent’s notification of that determination
to the Trustee and the Company, the Calculation Agent will substitute the Successor Basket Underlier as calculated by the relevant
Basket Underlier Sponsor or any other entity and calculate the Closing Level of such Basket Underlier as described above. Upon
any selection by the Calculation Agent of a Successor Basket Underlier, the Company will cause notice to be given to the Holder
of this Security.

 

In the event that
a Basket Underlier Sponsor discontinues publication of a Basket Underlier prior to, and the discontinuance is continuing on, the
Determination Date and the Calculation Agent determines that no Successor Basket Underlier is available at such time, the Calculation
Agent will calculate a substitute Closing Level for such Basket Underlier in accordance with the formula for and method of calculating
such Basket Underlier last in effect prior to the discontinuance, but using only those securities that comprised such Basket Underlier
immediately prior to that discontinuance. If a Successor Basket Underlier is selected or the Calculation Agent calculates a level
as a substitute for such Basket Underlier, the Successor Basket Underlier or level will be used as a substitute for such Basket
Underlier for all purposes, including the purpose of determining whether a Market Disruption Event exists.

 

If on the Determination
Date a Basket Underlier Sponsor fails to calculate and announce the level of a Basket Underlier, the Calculation Agent will calculate
a substitute Closing Level of such Basket Underlier in accordance with the formula for and method of calculating such Basket Underlier
last in effect prior to the failure, but using only those securities that comprised such

 

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Basket
Underlier immediately prior to that failure; provided that, if a Market Disruption Event occurs or is continuing on such
day with respect to such Basket Underlier, then the provisions set forth below under “Market Disruption Events” shall
apply in lieu of the foregoing.

 

Adjustments To A Basket Underlier

 

If at any time the
method of calculating a Basket Underlier or a Successor Basket Underlier, or the Closing Level thereof, is changed in a material
respect, or if a Basket Underlier or a Successor Basket Underlier is in any other way modified so that such Basket Underlier does
not, in the opinion of the Calculation Agent, fairly represent the level of such Basket Underlier had those changes or modifications
not been made, then the Calculation Agent will, at the close of business in New York, New York, on each date that the Closing Level
of such Basket Underlier is to be calculated, make such calculations and adjustments as, in the good faith judgment of the Calculation
Agent, may be necessary in order to arrive at a level of an index comparable to such Basket Underlier or Successor Basket Underlier
as if those changes or modifications had not been made, and the Calculation Agent will calculate the Closing Level of such Basket
Underlier or Successor Basket Underlier with reference to such index, as so adjusted. Accordingly, if the method of calculating
a Basket Underlier or Successor Basket Underlier is modified so that the level of such Basket Underlier is a fraction or a multiple
of what it would have been if it had not been modified (e.g., due to a split or reverse split in such basket underlier), then the
Calculation Agent will adjust such Basket Underlier or Successor Basket Underlier in order to arrive at a level of such Basket
Underlier as if it had not been modified (e.g., as if the split or reverse split had not occurred).

 

Market Disruption Events 

 

A “Market
Disruption Event” with respect to the TOPIX® Index, the FTSE® 100 Index, the Swiss
Market Index (SMI®) or the S&P/ASX 200 Index, means any of the following events as determined by the Calculation
Agent in its sole discretion:

 

		(A)	The occurrence or existence of a material suspension of or limitation imposed on trading by the
Relevant Stock Exchanges or otherwise relating to securities which then comprise 20% or more of the level of such Basket Underlier
or any Successor Basket Underlier at any time during the one-hour period that ends at the Close of Trading on that day, whether
by reason of movements in price exceeding limits permitted by those Relevant Stock Exchanges or otherwise.

 

		(B)	The occurrence or existence of a material suspension of or limitation imposed on trading by any
Related Futures or Options Exchange or otherwise in futures or options contracts relating to such Basket Underlier or any Successor
Basket Underlier on any Related Futures or Options Exchange at any time during the one-hour period that ends at the Close of Trading
on that day, whether by reason of movements in price exceeding limits permitted by the Related Futures or Options Exchange or otherwise.

 

		(C)	The occurrence or existence of any event, other than an early closure, that materially disrupts
or impairs the ability of market participants in general to effect transactions in, or obtain market values for, securities that
then comprise 20% or more of the level of such Basket Underlier or any Successor Basket Underlier on 

 

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their
Relevant Stock Exchanges at any time during the one-hour period that ends at the Close of Trading on that day.

 

		(D)	The occurrence or existence of any event, other than an early closure, that materially disrupts
or impairs the ability of market participants in general to effect transactions in, or obtain market values for, futures or options
contracts relating to such Basket Underlier or any Successor Basket Underlier on any Related Futures or Options Exchange at any
time during the one-hour period that ends at the Close of Trading on that day.

 

		(E)	The closure on any Exchange Business Day of the Relevant Stock Exchanges on which securities that
then comprise 20% or more of the level of such Basket Underlier or any Successor Basket Underlier are traded or any Related Futures
or Options Exchange with respect to such Basket Underlier or any Successor Basket Underlier prior to its Scheduled Closing Time
unless the earlier closing time is announced by the Relevant Stock Exchange or Related Futures or Options Exchange, as applicable,
at least one hour prior to the earlier of (1) the actual closing time for the regular trading session on such Relevant Stock Exchange
or Related Futures or Options Exchange, as applicable, and (2) the submission deadline for orders to be entered into the Relevant
Stock Exchange or Related Futures or Options Exchange, as applicable, system for execution at such actual closing time on that
day.

 

		(F)	The Relevant Stock Exchange for any security underlying such Basket Underlier or Successor Basket
Underlier or any Related Futures or Options Exchange with respect to such Basket Underlier or Successor Basket Underlier fails
to open for trading during its regular trading session.

 

For purposes of determining whether a Market
Disruption Event has occurred with respect to the TOPIX® Index, the FTSE® 100 Index, the Swiss
Market Index (SMI®) or the S&P/ASX 200 Index:

 

		(1)	the relevant percentage contribution of a security to the level of such Basket Underlier or any
Successor Basket Underlier will be based on a comparison of (x) the portion of the level of such basket underlier attributable
to that security and (y) the overall level of such Basket Underlier or Successor Basket Underlier, in each case immediately before
the occurrence of the Market Disruption Event;

 

		(2)	the “Close of Trading” on any Trading Day for such Basket Underlier or any Successor
Basket Underlier means the Scheduled Closing Time of the Relevant Stock Exchanges with respect to the securities underlying such
Basket Underlier or Successor Basket Underlier on such Trading Day; provided that, if the actual closing time of the regular trading
session of any such Relevant Stock Exchange is earlier than its Scheduled Closing Time on such Trading Day, then (x) for purposes
of clauses (A) and (C) of the definition of “Market Disruption Event” above, with respect to any security underlying
such Basket Underlier or Successor Basket Underlier for which such Relevant Stock Exchange is its Relevant Stock Exchange, the
“Close of Trading” means such actual closing time and (y) for purposes of clauses (B) and (D) of the definition of
“Market Disruption Event” above, with respect to any futures or options contract relating to such Basket 

 

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Underlier
or Successor Basket Underlier, the “close of trading” means the latest actual closing time of the regular trading
session of any of the Relevant Stock Exchanges, but in no event later than the Scheduled Closing Time of the Relevant Stock Exchanges;

 

		(3)	the “Scheduled Closing Time” of any Relevant Stock Exchange or Related Futures
or Options Exchange on any Trading Day for such Basket Underlier or any Successor Basket Underlier means the scheduled weekday
closing time of such Relevant Stock Exchange or Related Futures or Options Exchange on such Trading Day, without regard to after
hours or any other trading outside the regular trading session hours; and

 

		(4)	an “Exchange Business Day” means any Trading Day for such Basket Underlier or
any Successor Basket Underlier on which each Relevant Stock Exchange for the securities underlying such Basket Underlier or any
Successor Basket Underlier and each Related Futures or Options Exchange with respect to such Basket Underlier or any Successor
Basket Underlier are open for trading during their respective regular trading sessions, notwithstanding any such Relevant Stock
Exchange or Related Futures or Options Exchange closing prior to its Scheduled Closing Time.

 

A “Market
Disruption Event” with respect to the EURO STOXX 50® Index means, any of (A), (B), (C) or (D) below, as
determined by the Calculation Agent in its sole discretion:

 

		(A)	Any of the following events occurs or exists with respect to any security included in such Basket
Underlier or any Successor Basket Underlier, and the aggregate of all securities included in such Basket Underlier or Successor
Basket Underlier with respect to which any such event occurs comprise 20% or more of the level of such Basket Underlier or Successor
Basket Underlier:

 

		●	a material suspension of or limitation imposed on trading by the Relevant Stock Exchange for such
security or otherwise at any time during the one-hour period that ends at the Scheduled Closing Time for the Relevant Stock Exchange
for such security on that day, whether by reason of movements in price exceeding limits permitted by the Relevant Stock Exchange
or otherwise;

 

		●	any event, other than an early closure, that materially disrupts or impairs the ability of market
participants in general to effect transactions in, or obtain market values for, such security on its Relevant Stock Exchange at
any time during the one-hour period that ends at the Scheduled Closing Time for the Relevant Stock Exchange for such security on
that day; or

 

		●	the closure on any Exchange Business Day of the Relevant Stock Exchange for such security prior
to its Scheduled Closing Time unless the earlier closing is announced by such Relevant Stock Exchange at least one hour prior to
the earlier of (i) the actual closing time for the regular trading session on such Relevant Stock Exchange and (ii) the submission
deadline 

 

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for
orders to be entered into the Relevant Stock Exchange system for execution at the Scheduled Closing Time for such Relevant Stock
Exchange on that day.

 

		(B)	Any of the following events occurs or exists with respect to futures or options contracts relating
to such Basket Underlier or any Successor Basket Underlier:

 

		●	a material suspension of or limitation imposed on trading by any Related Futures or Options Exchange
or otherwise at any time during the one-hour period that ends at the Close of Trading on such Related Futures or Options Exchange
on that day, whether by reason of movements in price exceeding limits permitted by the Related Futures or Options Exchange or otherwise;

 

		●	any event, other than an early closure, that materially disrupts or impairs the ability of market
participants in general to effect transactions in, or obtain market values for, futures or options contracts relating to such Basket
Underlier or Successor Basket Underlier on any Related Futures or Options Exchange at any time during the one-hour period that
ends at the Close of Trading on such Related Futures or Options Exchange on that day; or

 

		●	the closure on any Exchange Business Day of any Related Futures or Options Exchange prior to its
Scheduled Closing Time unless the earlier closing time is announced by such Related Futures or Options Exchange at least one hour
prior to the earlier of (i) the actual closing time for the regular trading session on such Related Futures or Options Exchange
and (ii) the submission deadline for orders to be entered into the related futures or options exchange system for execution at
the Close of Trading for such Related Futures or Options Exchange on that day.

 

		(C)	The relevant Basket Underlier Sponsor fails to publish the level of such Basket Underlier or any
Successor Basket Underlier (other than as a result of the relevant Basket Underlier Sponsor having discontinued publication of
such Basket Underlier or Successor Basket Underlier and no Successor Basket Underlier being available).

 

		(D)	Any Related Futures or Options Exchange fails to open for trading during its regular trading session.

 

For purposes of determining whether a Market
Disruption Event has occurred with respect to the EURO STOXX 50® Index:

 

		(1)	the relevant percentage contribution of a security included in such Basket Underlier or any Successor
Basket Underlier to the level of such Basket Underlier will be based on a comparison of (x) the portion of the level of such basket
underlier attributable to that security to (y) the overall level of such Basket 

 

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Underlier,
in each case using the official opening weightings as published by the relevant Basket Underlier Sponsor as part of the market
opening data;

 

		(2)	the “Scheduled Closing Time” of any Relevant Stock Exchange or Related Futures
or Options Exchange on any Trading Day means the scheduled weekday closing time of such Relevant Stock Exchange or Related Futures
or Options Exchange on such Trading Day, without regard to after hours or any other trading outside the regular trading session
hours; and

 

		(3)	an “Exchange Business Day” means any trading day on which (i) the relevant Basket
Underlier Sponsor publishes the level of such Basket Underlier or any Successor Basket Underlier and (ii) each Related Futures
or Options Exchange is open for trading during its regular trading session, notwithstanding any Related Futures or Options Exchange
closing prior to its Scheduled Closing Time.

 

If a Market Disruption Event occurs or
is continuing with respect to any Basket Underlier on the Determination Date, then the Determination Date for such Basket Underlier
will be postponed to the first succeeding Trading Day for such Basket Underlier on which a Market Disruption Event for such Basket
Underlier has not occurred and is not continuing; however, if such first succeeding Trading Day has not occurred as of the eighth
Trading Day for such Basket Underlier after the originally scheduled Determination Date, that eighth Trading Day shall be deemed
to be the Determination Date for such Basket Underlier. If the Determination Date has been postponed eight Trading Days for a Basket
Underlier after the originally scheduled Determination Date and a Market Disruption Event occurs or is continuing with respect
to such Basket Underlier on such eighth Trading Day, the Calculation Agent will determine the Closing Level of such Basket Underlier
on such eighth Trading Day in accordance with the formula for and method of calculating the Closing Level of such Basket Underlier
last in effect prior to commencement of the Market Disruption Event, using the closing price (or, with respect to any relevant
security, if a Market Disruption Event has occurred with respect to such security, its good faith estimate of the value of such
security at (i) with respect to the TOPIX® Index, the FTSE® 100 Index, the Swiss Market Index
(SMI®) and the S&P/ASX 200 Index, the Scheduled Closing Time of the Relevant Stock Exchange for such security
or, if earlier, the actual closing time of the regular trading session of such Relevant Stock Exchange or (ii) with respect to
the EURO STOXX 50® Index, the time at which the official closing level of that Basket Underlier is calculated and
published by the relevant Basket Underlier Sponsor) on such date of each security included in such Basket Underlier. As used herein,
“closing price” means, with respect to any security on any date, the Relevant Stock Exchange traded or quoted
price of such security as of (i) with respect to the TOPIX® Index, the FTSE® 100 Index, the
Swiss Market Index (SMI®) or the S&P/ASX 200 Index, the Scheduled Closing Time of the Relevant Stock Exchange
for such security or, if earlier, the actual closing time of the regular trading session of such Relevant Stock Exchange or (ii)
with respect to the EURO STOXX 50® Index, the time at which the official closing level of such Basket Underlier
is calculated and published by the relevant Basket Underlier Sponsor. Notwithstanding the postponement of the determination date
for a Basket Underlier due to a Market Disruption Event with respect to such Basket Underlier on the Determination Date, the originally
scheduled Determination Date will remain the Determination Date for any Basket Underlier not affected by a Market Disruption Event
on such day.

 

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Calculation Agent

 

The Calculation Agent
will determine the Cash Settlement Amount and the Final Basket Level. In addition, the Calculation Agent will (i) determine if
adjustments are required to the Closing Level of a Basket Underlier under the circumstances described in this Security, (ii) if
publication of a Basket Underlier is discontinued, select a Successor Basket Underlier or, if no Successor Basket Underlier is
available, determine the Closing Level of such Basket Underlier under the circumstances described in this Security, and (iii) determine
whether a Market Disruption Event or non-Trading Day has occurred.

 

The Company covenants
that, so long as this Security is Outstanding, there shall at all times be a Calculation Agent (which shall be a broker-dealer,
bank or other financial institution) with respect to this Security.

 

All determinations
made by the Calculation Agent with respect to this Security will be at the sole discretion of the Calculation Agent and, in the
absence of manifest error, will be conclusive for all purposes and binding on the Company and the Holder of this Security.

 

Tax Considerations

 

The Company agrees,
and by acceptance of a beneficial ownership interest in this Security each Holder of this Security will be deemed to have agreed
(in the absence of a statutory, regulatory, administrative or judicial ruling to the contrary), for United States federal income
tax purposes to characterize and treat this Security as a prepaid derivative contract that is an “open transaction.”

 

Redemption and Repayment

 

This Security is not
subject to redemption at the option of the Company or repayment at the option of the Holder hereof prior to August 30, 2021. This
Security is not entitled to any sinking fund.

 

Acceleration

 

If an Event of Default,
as defined in the Indenture, with respect to this Security shall occur and be continuing, the Cash Settlement Amount (calculated
as set forth in the next sentence) of this Security may be declared due and payable in the manner and with the effect provided
in the Indenture. The amount payable to the Holder hereof upon any acceleration permitted under the Indenture will be equal to
the Cash Settlement Amount hereof calculated as provided herein as though the date of acceleration was the Determination Date.

 

 

 

Reference is hereby
made to the further provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes
have the same effect as if set forth at this place.

 

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Unless the certificate
of authentication hereon has been executed by the Trustee referred to on the reverse hereof by manual signature or its duly authorized
agent under the Indenture referred to on the reverse hereof by manual signature, this Security shall not be entitled to any benefit
under the Indenture or be valid or obligatory for any purpose.

 

[The remainder of this page
has been left intentionally blank]

 

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IN WITNESS WHEREOF, the Company has caused
this instrument to be duly executed.

 

	
DATED:

	
 

	
 

	
 

	
 

	
 

	
 

	
WELLS FARGO FINANCE LLC

	
 

	
 

	
 

	
By:

	
 

	
 

	
 

	
 

	
 

	
 

	
Its:

 

	
 

	
Attest:

	
 

	
 

	
 

	
 

	
 

	
 

	
Its:

 

	
TRUSTEE’S CERTIFICATE OF 

AUTHENTICATION

	
 

	

This is one of the Securities of the series
designated therein described in the within-mentioned Indenture.

	
 

	
 

	
 

	
 

	
CITIBANK, N.A.,

	
 

	
 

	
as Trustee

	
 

	 	 	 
	
By:

	
 

	
 

	
 

	
Authorized Signature

	
 

	
 

	
 

	
 

	
OR

	
 

	
 

	
 

	
 

	
WELLS FARGO BANK, N.A.,

	
 

	
as Authenticating Agent for the Trustee

	
 

	
 

	
 

	
 

	
By:

	
 

	
 

	
 

	
Authorized Signature

	
 

 

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[Reverse of Note]

 

WELLS FARGO FINANCE LLC

 

MEDIUM-TERM NOTE, SERIES A

 

Fully and Unconditionally Guaranteed
by Wells Fargo & Company

 

Principal at Risk Securities Linked
to an International Equity Index Basket

 

This Security is one
of a duly authorized issue of securities of the Company (herein called the “Securities”), issued and to be issued
in one or more series under an indenture dated as of April 25, 2018, as amended or supplemented from time to time (herein called
the “Indenture”), among the Company, as issuer, Wells Fargo & Company, as guarantor (the “Guarantor”)
and Citibank, N.A., as trustee (herein called the “Trustee,” which term includes any successor trustee under
the Indenture), to which Indenture and all indentures supplemental thereto reference is hereby made for a statement of the respective
rights, limitations of rights, duties and immunities thereunder of the Company, the Guarantor the Trustee and the Holders of the
Securities, and of the terms upon which the Securities are, and are to be, authenticated and delivered. This Security is one of
the series of the Securities designated as Medium-Term Notes, Series A, of the Company. The amount payable on the Securities of
this series may be determined by reference to the performance of one or more equity-, commodity- or currency-based indices, exchange
traded funds, securities, commodities, currencies, statistical measures of economic or financial performance, or a basket comprised
of two or more of the foregoing, or any other market measure or may bear interest at a fixed rate or a floating rate. The Securities
of this series may mature at different times, be redeemable at different times or not at all, be repayable at the option of the
Holder at different times or not at all and be denominated in different currencies.

 

The Securities are
issuable only in registered form without coupons and will be either (a) book-entry securities represented by one or more Global
Securities recorded in the book-entry system maintained by the Depositary or (b) certificated securities issued to and registered
in the names of, the beneficial owners or their nominees.

 

The Company agrees,
to the extent permitted by law, not to voluntarily claim the benefits of any laws concerning usurious rates of interest against
a Holder of this Security.

 

Guarantee 

 

The Securities of this
series are fully and unconditionally guaranteed by the Guarantor as and to the extent set forth in the Indenture.

 

Modification and Waivers 

 

The Indenture permits,
with certain exceptions as therein provided, the amendment thereof and the modification of the rights and obligations of the Company
and the Guarantor and the rights of the Holders of the Securities of each series to be affected under the Indenture at any time
by the

 

    13

     

    

 

Company,
the Guarantor and the Trustee with the consent of the Holders of a majority in principal amount of the Securities at the time
Outstanding of all series to be affected, acting together as a class. The Indenture also contains provisions permitting the Holders
of a majority in principal amount of the Securities of all series at the time Outstanding affected by certain provisions of the
Indenture, acting together as a class, on behalf of the Holders of all Securities of such series, to waive compliance by the Company
or the Guarantor with those provisions of the Indenture. Certain past defaults under the Indenture and their consequences may
be waived under the Indenture by the Holders of a majority in principal amount of the Securities of each series at the time Outstanding,
on behalf of the Holders of all Securities of such series. Solely for the purpose of determining whether any consent, waiver,
notice or other action or Act to be taken or given by the Holders of Securities pursuant to the Indenture has been given or taken
by the Holders of Outstanding Securities in the requisite aggregate principal amount, the principal amount of this Security will
be deemed to be equal to the amount set forth on the face hereof as the “Face Amount” hereof. Any such consent or
waiver by the Holder of this Security shall be conclusive and binding upon such Holder and upon all future Holders of this Security
and of any Security issued upon the registration of transfer hereof or in exchange herefor or in lieu hereof, whether or not notation
of such consent or waiver is made upon this Security.

 

Defeasance

 

Section 403 and
Article Fifteen of the Indenture and the provisions of clause (ii) of Section 401(1)(B) of the Indenture, relating to
defeasance at any time of (a) the entire indebtedness on this Security and (b) certain restrictive covenants, upon compliance
by the Company or the Guarantor with certain conditions set forth therein, shall not apply to this Security. The remaining provisions
of Section 401 of the Indenture shall apply to this Security.

 

Authorized Denominations

 

This Security is issuable
only in registered form without coupons in denominations of $1,000 or any amount in excess thereof which is an integral multiple
of $1,000.

 

Registration of Transfer

 

Upon due presentment
for registration of transfer of this Security at the office or agency of the Company in the City of Minneapolis, Minnesota, a new
Security or Securities of this series, with the same terms as this Security, in authorized denominations for an equal aggregate
Face Amount will be issued to the transferee in exchange herefor, as provided in the Indenture and subject to the limitations provided
therein and to the limitations described below, without charge except for any tax or other governmental charge imposed in connection
therewith.

 

This Security is exchangeable
for definitive Securities in registered form only if (x) the Depositary notifies the Company that it is unwilling or unable
to continue as Depositary for this Security or if at any time the Depositary ceases to be a clearing agency registered under the
Securities Exchange Act of 1934, as amended, and a successor depositary is not appointed within 90 days after the Company
receives such notice or becomes aware of such ineligibility, (y) the Company in its sole discretion determines that this Security
shall be exchangeable for definitive Securities in registered form and notifies the Trustee thereof or (z) an Event of Default
with respect

 

    14

     

    

 

to
the Securities represented hereby has occurred and is continuing. If this Security is exchangeable pursuant to the preceding sentence,
it shall be exchangeable for definitive Securities in registered form, having the same date of issuance, Stated Maturity Date
and other terms and of authorized denominations aggregating a like amount.

 

This Security may not
be transferred except as a whole by the Depositary to a nominee of the Depositary or by a nominee of the Depositary to the Depositary
or another nominee of the Depositary or by the Depositary or any such nominee to a successor of the Depositary or a nominee of
such successor. Except as provided above, owners of beneficial interests in this Global Security will not be entitled to receive
physical delivery of Securities in definitive form and will not be considered the Holders hereof for any purpose under the Indenture.

 

Prior to due presentment
of this Security for registration of transfer, the Company, the Guarantor, the Trustee and any agent of the Company, the Guarantor
or the Trustee may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or
not this Security be overdue, and neither the Company, the Guarantor, the Trustee nor any such agent shall be affected by notice
to the contrary.

 

Obligation of the Company Absolute

 

No reference herein
to the Indenture and no provision of this Security or the Indenture shall alter or impair the obligation of the Company, which
is absolute and unconditional, to pay the Cash Settlement Amount at the times, place and rate, and in the coin or currency, herein
prescribed, except as otherwise provided in this Security.

 

No Personal Recourse

 

No recourse shall be
had for the payment of the Cash Settlement Amount, or for any claim based hereon, or otherwise in respect hereof, or based on or
in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer or director,
as such, past, present or future, of the Company or any successor corporation or of the Guarantor or any successor corporation,
whether by virtue of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise,
all such liability being, by the acceptance hereof and as part of the consideration for the issuance hereof, expressly waived and
released.

 

Defined Terms

 

All terms used in this
Security which are defined in the Indenture shall have the meanings assigned to them in the Indenture unless otherwise defined
in this Security.

 

Governing Law

 

This Security shall
be governed by and construed in accordance with the law of the State of New York, without regard to principles of conflicts of
laws.

 

    15

     

    

 

ABBREVIATIONS

 

The following abbreviations,
when used in the inscription on the face of this instrument, shall be construed as though they were written out in full according
to applicable laws or regulations:

 

	
TEN COM

	
--

	
as tenants in common

	
 

	
 

	
 

	
TEN ENT

	
--

	
as tenants by the entireties

	
 

	
 

	
 

	
JT TEN

	
--

	
as joint tenants with right

	
 

	
 

	
of survivorship and not

	
 

	
 

	
as tenants in common

 

	
UNIF GIFT MIN ACT

	
--

	
 

	
Custodian

	
 

	
 

	
 

	
(Cust)

	
 

	
(Minor)

 

Under Uniform Gifts to Minors Act

 

	
 

	
 

	
(State)

	
 

 

Additional abbreviations
may also be used though not in the above list.

 

FOR VALUE RECEIVED,
the undersigned hereby sell(s) and transfer(s) unto

 

Please Insert Social Security or

Other Identifying Number of Assignee

 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

(Please
print or type name and address including postal zip code of Assignee)

 

    16

     

    

 

the within Security of WELLS FARGO FINANCE
LLC and does hereby irrevocably constitute and appoint __________________ attorney to transfer the said Security on the books of
the Company, with full power of substitution in the premises.

 

	
Dated:

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

 

NOTICE: The signature to this assignment
must correspond with the name as written upon the face of the within instrument in every particular, without alteration or enlargement
or any change whatever.

 

    17Exhibit 10.8

EXHIBIT 10.8

 

MECHANICAL TECHNOLOGY, INCORPORATED

RESTRICTED STOCK AWARD AGREEMENT 

 

This RESTRICTED STOCK AWARD AGREEMENT (this "Agreement")
is dated as of _______ __, ____ ("Grant Date"), and is made by and
between Mechanical Technology, Incorporated, a New York corporation (the "Company"),
and ______________, an individual resident of the State of New York and
[officer] [director] of the Company ("Grantee").   Company and
Grantee are sometimes referred to herein, individually, as a "party"
and, collectively, as the "parties".

RECITALS

WHEREAS, the Company has adopted the Mechanical
Technology, Incorporated 2012 Equity Incentive Plan (Effective June 14, 2012
and amended and restated on October 20, 2016) (the "Plan"), under which
awards of restricted shares of the Company's common stock may be granted; and

WHEREAS, the Compensation Committee of the board of
directors of the Company (the "Compensation Committee"), in its
capacity as administrator under the Plan ("Administrator"), has
determined that it is in the best interests of the Company and its shareholders
to grant the award of Restricted Stock (as defined below) provided for herein.

NOW, THEREFORE, for good and valuable consideration,
receipt of which is acknowledged, the parties agree as follows:

1.         Grant and Issuance of Restricted Stock.  

(a)              
Pursuant to the Plan, the Company hereby issues to Grantee, on
the Grant Date, a Restricted Stock Award consisting of, in the aggregate, _______________
(_____) shares of common stock of the Company (the "Restricted Stock"),
on the terms and conditions and subject to the restrictions set forth in this
Agreement and the Plan. Capitalized terms that are used but not defined herein
have the meaning ascribed to them in the Plan.

(b)              
The grant of Restricted Stock pursuant to this Agreement is being
made in consideration for the performance of past services provided, and/or
future services to be provided, by Grantee to or for the benefit of the Company
and its affiliates.

(c)              
As of the Grant Date, the Fair Market Value of each share of
common stock of the Company underlying the Restricted Stock is $____ per
share.  

2.         Vesting.  

(a)              
Subject to Grantee's continuous employment by or continued
relationship as an individual services provider or director of the Company
and/or its affiliates ("Continuous Service") through the applicable
vesting date, the Restricted Stock granted and issued hereby shall become
vested as follows: [____________________________].  The period over which
applicable shares of Restricted Stock remain unvested is referred to as the "Restricted
Period" with respect to solely such applicable shares of unvested
Restricted Stock (such that, for the avoidance of doubt, upon vesting any
Vested Stock shall no longer be considered within the Restricted Period). 
Shares of Restricted Stock that have vested in accordance with the provisions
of this Section 2 are referred to as "Vested Stock".  Shares of
Restricted Stock that have not vested in accordance with the provisions of this
Section 2 are referred to as "Unvested Stock".  

(b)              
If Grantee's Continuous Service terminates for any reason, other
than death or disability (as defined in the Plan), at any time before all of
his or her Restricted Stock has vested, Grantee's Unvested Stock shall be
automatically forfeited upon such termination of Continuous Service and neither
the Company nor any affiliate of the Company shall have any further obligations
to Grantee under this Agreement with respect to such Unvested Stock.

(c)              
The foregoing vesting schedule notwithstanding, if Grantee's
Continuous Service terminates due to Grantee's death, 100% of the Unvested
Stock shall vest as of the date of such termination.

(d)              
The foregoing vesting schedule notwithstanding, if Grantee's
Continuous Service is terminated by the Company or an affiliate of the Company
due to a disability (as defined in the Plan), 100% of the Unvested Stock shall
vest as of the date of such termination.

(e)              
The foregoing vesting schedule notwithstanding, upon the
occurrence of a Substantial Corporate Change, 100% of the Unvested Stock shall
vest as of the date of the Substantial Corporate Change.

3.         Restrictions.  Notwithstanding the section of the Plan
entitled "Transfers, Assignments, And Pledges", but subject to any other
exceptions set forth in this Agreement or the Plan, following the Restricted
Period, the applicable shares of Vested Stock or the rights relating thereto
may be assigned, alienated, pledged, attached, sold or otherwise transferred or
encumbered by Grantee.  During the Restricted Period, the applicable shares of
Restricted Stock or the rights relating thereto may not be assigned, alienated,
pledged, attached, sold or otherwise transferred or encumbered by Grantee.  Any
attempt to assign, alienate, pledge, attach, sell or otherwise transfer or
encumber the applicable shares of Restricted Stock or the rights relating
thereto during the Restricted Period shall be wholly ineffective and, if any
such attempt is made, the applicable shares of Restricted Stock will be
forfeited by Grantee and all of Grantee's rights to such shares shall
immediately terminate without any payment or consideration by the Company.  

4.          Rights as a Shareholder; Dividends.

(a)              
Grantee shall be the record owner of the Restricted Stock until
the applicable underlying shares of common stock of the Company are sold or
otherwise disposed of, and shall be entitled to all of the rights of a
shareholder of the Company including, without limitation, the right to vote
such shares and receive all dividends or other distributions paid with respect
to such shares.  Notwithstanding the foregoing, any dividends or other
distributions that are not in the form of cash shall be subject to the same
restrictions on transferability as the shares of Restricted Stock with respect
to which they were paid.

 

2

(b)              
The Company may issue stock certificates or evidence Grantee's
interest by using a restricted book entry account with the Company's transfer
agent, in the Company's sole discretion.

(c)              
If Grantee forfeits any rights he or she has under this Agreement
in accordance with Section 2 of this Agreement, Grantee shall, on the
date of such forfeiture, no longer have any rights as a shareholder with
respect to the applicable Restricted Stock so forfeited and shall no longer be
entitled to vote or receive dividends on such shares.

5.         No Right to Continued Employment or Service.  Neither the
Plan nor this Agreement shall confer upon Grantee any right to be employed or
retained by the Company or its affiliates as a director, employee, consultant
or in any other capacity.  Further, nothing in the Plan or this Agreement shall
be construed to limit the discretion of the Company or its affiliates to
terminate Grantee's Continuous Service at any time.

6.          Adjustments.
If any change is made to the outstanding common stock of the Company or the capital
structure of the Company, the shares of common stock of the Company underlying
the Restricted Stock shall, if required, be adjusted in any manner as
contemplated by the Plan.

7.          Tax.  Grantee agrees that, within 30 days after the date
hereof, Grantee shall give notice to the Company on the form attached hereto as
Exhibit A as to the making of an election pursuant to section 83(b) of
the Internal Revenue Code with respect to the Restricted Stock acquired as of
the Grant Date.  Grantee acknowledges that Grantee will be solely responsible
for any and all tax liabilities payable by Grantee in connection with Grantee's
acquisition of the Restricted Stock or attributable to Grantee's making or
failing to make such an election.  The form for making the section 83(b)
election is attached hereto as Exhibit B.  Grantee agrees to consult
with his or her tax advisor to determine the tax consequences of acquiring the
Restricted Stock and the advantages and disadvantages of filing the section
83(b) election.  The Company (i) makes no representation or undertaking
regarding the treatment of any income tax, social insurance, payroll tax or
other tax-related withholding ("Tax-Related Items") in connection with
the grant or vesting of the Restricted Stock or the subsequent sale of any
shares underlying the Restricted Stock and (ii) does not commit to structure
the Restricted Stock to reduce or eliminate Grantee's liability for any
Tax-Related Items.

8.           Compliance
with Law.  The issuance and transfer of the Restricted Stock, and
the shares of common stock underlying such Restricted Stock, shall be subject
to compliance by the Company and Grantee with all applicable requirements of
federal and state securities laws and with all applicable requirements of any
stock exchange on which the Company's shares of common stock may be listed.  No
shares of Restricted Stock or common stock of the Company underlying the
Restricted Stock shall be issued or transferred unless and until any then
applicable requirements of state and federal laws and regulatory agencies have
been fully complied with to the satisfaction of the Company and its counsel. 
Grantee understands that the Company is under no obligation to register the
Restricted Stock or shares of common stock of the Company underlying the
Restricted Stock with the United States Securities and Exchange Commission, any
state securities commission or any stock exchange to effect such compliance.

3

 

9.         Miscellaneous.

(a)              
Legends.
A legend may be placed on any certificate(s) or other document(s) delivered to
Grantee indicating restrictions on transferability of the shares of Restricted
Stock pursuant to this Agreement or any other restrictions that the Committee
may deem advisable under the rules, regulations and other requirements of the
U.S. Securities and Exchange Commission, any applicable federal or state
securities laws or any stock exchange on which the shares of common stock of
the Company are then listed or quoted.

(b)              
Governing Law.  This Agreement shall be governed by and
construed in accordance with the laws of the State of New York, without giving
effect to any choice or conflicts of law provision or rule (whether of the
State of New York or any other jurisdiction) that would cause the application
of the laws of any jurisdiction other than the State of New York.

(c)              
Interpretation; Jurisdiction.  The Committee shall have
full authority to interpret, construe and administer this Agreement, and the
Committee's reasonable interpretation and construction hereof, and reasonable
actions hereunder, shall be final, binding and conclusive on all persons for
all purposes; provided, that, if any such interpretation, construction
or administration of this Agreement involves a director of the Company
then-serving on the Committee as Grantee hereunder, such director shall be
recused from the Committee for the purposes of such interpretation,
construction or administration.  Subject to the foregoing, in the event of a
judicial proceeding involving any dispute, controversy or claim arising out of
or relating to this Agreement, Grantee and the Company unconditionally accept
the exclusive jurisdiction and venue of any federal or state located in or for
the State of New York.  In any such judicial proceeding, Grantee and the
Company agree that in addition to any method for the service of process
permitted or required by such courts, to the fullest extent permitted by law,
service of process may be made by prepaid certified mail with a proof of
mailing receipt validated by the U.S. Postal Service constituting evidence of valid
service.  GRANTEE AND THE COMPANY HEREBY WAIVE TRIAL BY JURY IN ANY JUDICIAL
PROCEEDING INVOLVING ANY DISPUTE, CONTROVERSY OR CLAIM ARISING OUT OF OR
RELATING TO THIS AGREEMENT.

(d)              
Withholding Taxes.  All Restricted Stock acquired pursuant
hereto and allocations or distributions with respect to such Restricted Stock
and the common stock of the Company underlying such Restricted Stock shall be
subject to withholding as required by applicable federal, state and local laws,
and the Company may make such arrangements for the payment of any withholding
taxes with respect to such Restricted Stock and the common stock of the Company
underlying such Restricted Stock as the Company deems satisfactory.

(e)              
Severability.  In the event that any one or more of the
provisions of this Agreement shall be or become invalid, illegal or
unenforceable in any respect, the validity, legality and enforceability of the
remaining provisions contained herein shall not be affected thereby.

(f)               
Binding Effect; Assignment.  This Agreement shall be
binding on and inure to the benefit of the Company and its respective
successors and permitted assigns.  This Agreement shall also be binding on and
inure to the benefit of Grantee and Grantee's heirs, executors, administrators
and legal representatives.  This Agreement shall not be
assignable by any party hereto without the prior written consent of the other
party hereto, except as provided pursuant to this Section 9(f).  The
Company may effect such an assignment without prior written approval of Grantee
upon a Substantial Corporate Change or any other sale of the Company or the
transfer of all or substantially all of its business and/or assets (by whatever
means).

4

(g)              
Discretionary
Nature of Plan. The Plan is discretionary and may be amended,
cancelled or terminated by the Company in the manner provided for in the Plan. 
The grant of the Restricted Stock in this Agreement does not create any
contractual right or other right to receive additional restricted stock or
other Awards in the future.  Future Awards, if any, will be at the sole
discretion of the Company.

(h)              
Notice.  Any notice required to be delivered to the
Company under this Agreement shall be in writing and addressed to the Chief
Executive Officer of the Company at the Company's principal corporate offices. 
Any notice required to be delivered to Grantee under this Agreement shall be in
writing and addressed to Grantee at Grantee's address as shown in the records
of the Company.  Either party may designate another address in writing (or by
such other method approved by the Company) from time to time.

(i)                
Entire Agreement.  This Agreement and Plan constitute the
entire agreement between the parties, and supersede all prior agreements and
understandings relating to the subject matter of this Agreement.

(j)                
Amendments; Waiver.  No provision of this Agreement may be
modified, waived or discharged unless such modification, waiver or discharge is
approved in writing by an authorized officer of the Company (that is not
Grantee) and is either agreed to in writing by Grantee or otherwise authorized
by the Plan.  No waiver by any party hereto at any time of any breach by any
other party hereto of, or compliance with, any condition or provision of this
Agreement to be performed by such other party shall be deemed a waiver of
similar or dissimilar provisions or conditions at the same or at any prior or
subsequent time.  No waiver of any provision of this Agreement shall be implied
from any course of dealing between or among the parties hereto or from any
failure by any party hereto to assert its rights hereunder on any occasion or
series of occasions.

(k)              
Counterparts.  This Agreement may be executed in one or
more counterparts (including by means of a facsimile or portable document
format), each of which shall be deemed an original but all of which together
shall constitute one and the same instrument. 

(l)                
Headings.  The headings contained in this Agreement are
for reference only and shall not under any circumstances be deemed to affect
the meaning or interpretation of this Agreement.

[signature page
follows]

 

5

 

IN WITNESS WHEREOF, the parties have executed this Agreement as of
the day and year first above written.

 

		

MECHANICAL
TECHNOLOGY, INCORPORATED

			
	

 

			
	

 

			
	

By:                                                                              

			
	

      Name:

			
	

      Title:

			
	

 

			
	

 

			
	

Grantee:

			
	

 

			
	

 

			
	

 

			
	

                                                                                    

			
	

[Name]

			

 

[Signature Page to Restricted Stock Award Agreement]

 

Exhibit A

 

[DATE]

 

Mechanical Technology,
Incorporated

325 Washington Avenue, Extension

Albany, New York 12205

Attention:  Chief Executive Officer

Email:  rjones@mtiinstruments.com

           

    Notification
of Section 83(b) Election 

 

To whom it may concern:

 

    On _________ __, ____, I acquired ___________ (_____) restricted common
stock shares (the "Restricted Stock") of Mechanical Technology,
Incorporated pursuant to a Restricted Stock Award Agreement, dated as of such
date (the "Agreement").  Pursuant to Section 7 of the Agreement, I
hereby notify you that:

    [  ]        I have made an election under Section 83(b) of the Internal
Revenue Code (the "Code") with respect to the Restricted Stock.

    [  ]        I have not yet made an election under Section 83(b) of the
Code with respect to the Restricted Stock, but I intend to do so no later than
the date which is 30 days after the acquisition of the Restricted Stock.

    [  ]        I do not intend to make an election under Section 83(b) of
the Code with respect to the Restricted Stock.

    I also acknowledge pursuant to Section 7 of the Agreement that I am
solely responsible for any and all tax liabilities payable in connection with
the Restricted Stock or attributable to my decision regarding the election
under Section 83(b) of the Internal Revenue Code.

 

Signature:_______________________

Printed
Name____________________

Date___________________________

 

A-1

 

Exhibit B

 

Section 83(b) Election

The undersigned taxpayer hereby makes this election
pursuant to Section 83(b) of the Internal Revenue Code of 1986, as amended (the
"Code"),
and Treasury Regulations Section 1.83-2 promulgated thereunder.

 

1.         The name, taxpayer
identification number, address of the undersigned, and the taxable year for
which this election is being made are:

                                                

      Taxpayer's Name: 
________________________________

      Taxpayer's Social Security Number:___________________

      Address: _______________________________________

_________________________ _____________

Taxable Year:  Calendar Year ____

2.         The property which is the subject of this election is
__________________ restricted shares of common stock of Mechanical Technology,
Incorporated, a New York corporation (the "Company").

 

3.         The restricted shares of common stock were transferred to the
undersigned on ________ __, ____.  This election is being made with respect to
the calendar year ____.

 

4.         The restricted shares of common stock are subject to the
following restrictions:  the restricted shares of common stock are subject to
time based vesting conditions and restrictions on transferability during a
restricted period with respect thereto.

 

5.         The fair market value of the restricted shares of common
stock at the date of transfer (determined without regard to any restriction
other than a nonlapse restriction, as defined in Section 1.83-3(h) of the
Income Tax Regulations) was $________________________, based on a fair market value
of $____ per share. 

 

6.         The amount paid for the restricted shares of common stock was
$______.

 

7.         The amount to include in gross income is $___________________
(the result of the amount reported in Item 5 minus the amount reported in Item
6).

 

The undersigned
taxpayer will file this election with the Internal Revenue Service office with
which taxpayer files his or her annual income tax return not later than 30 days
after the date of transfer of the property.  A copy of the election will also
be furnished to the person for whom the services were performed.  Additionally,
the undersigned will include a copy of the election with his or her income tax
return for the taxable year in which the property is transferred.  The
undersigned is the person performing the services in connection with which the
property was transferred.  The undersigned
understands that the foregoing election may not be revoked except with the
consent of the Internal Revenue Commissioner.

 

Dated:_______________________                           ___________________________________

                                                                                    Taxpayer

 

 

 

 

B-1

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