Document:

Exhibit

Exhibit 10.41

Fidelity National Financial, Inc.
Amended and Restated
2005 Omnibus Incentive Plan

Notice of Restricted Stock Grant

You (the “Grantee”) have been granted the following award of restricted Shares of Common Stock (the “Restricted Stock”), par value $0.0001 per share (the “Shares”), by Fidelity National Financial, Inc. (the “Company”), pursuant to the Fidelity National Financial, Inc. Amended and Restated 2005 Omnibus Incentive Plan (the “Plan”) and the terms set forth in the attached Restricted Stock Award Agreement:
    
	
		
	Name of Grantee:
	 

	Number of Shares of Restricted Stock Granted:
	 

	Effective Date of Grant:
	October 26, 2018

	Vesting and Period of Restriction:
	Subject to the terms of the Plan and the Restricted Stock Award Agreement attached hereto, the Period of Restriction shall lapse, and the Shares shall vest and become free of the forfeiture provisions contained in the Restricted Stock Award Agreement, with respect to one third of the shares on each anniversary of the Effective Date of Grant and satisfaction of the Performance Restriction as set forth on Exhibit A of the Restricted Stock Award Agreement, attached hereto.

By your electronic acceptance/signature below, you agree and acknowledge that the Restricted Stock is granted under and governed by the terms and conditions of the Plan and the attached Restricted Stock Award Agreement, which are incorporated herein by reference, and that you have been provided with a copy of the Plan and Restricted Stock Award Agreement. If you have not accepted or declined this Restricted Stock Grant, including the terms of this Notice and Restricted Stock Award Agreement, prior to the first anniversary of the Effective Date of Grant, you are hereby advised and acknowledge that you shall be deemed to have accepted the terms of this Notice and Restricted Stock Award Agreement on such first anniversary of the Effective Date of Grant.

    

Fidelity National Financial, Inc.
Amended and Restated 2005 Omnibus Incentive Plan 

Restricted Stock Award Agreement

		
	Section 1.  
	GRANT OF RESTRICTED STOCK

(a)  Restricted Stock.  On the terms and conditions set forth in the Notice of Restricted Stock Grant and this Restricted Stock Award Agreement (the “Agreement”), the Company grants to the Grantee on the Effective Date of Grant the Shares of Restricted Stock (the “Restricted Stock”) set forth in the Notice of Restricted Stock Grant. 

(b)  Plan and Defined Terms.  The Restricted Stock is granted pursuant to the Plan.  All terms, provisions, and conditions applicable to the Restricted Stock set forth in the Plan and not set forth herein are hereby incorporated by reference herein.  To the extent any provision hereof is inconsistent with a provision of the Plan, the provisions of the Plan will govern.  All capitalized terms that are used in the Notice of Restricted Stock Grant or this Agreement and not otherwise defined therein or herein shall have the meanings ascribed to them in the Plan. 

		
	Section 2.  
	FORFEITURE AND TRANSFER RESTRICTIONS 

(a)  Forfeiture.  Except as otherwise provided in Grantee’s employment, director services or similar agreement in effect at the time of the employment termination:

(i)If the Grantee’s employment or service as a Director or Consultant is terminated for any reason other than death, or Disability (as defined below), the Grantee shall, for no consideration, forfeit to the Company the Shares of Restricted Stock to the extent such Shares are subject to a Period of Restriction at the time of such termination. 

(ii)If the Grantee’s employment or service as a Director or Consultant is terminated due to the Grantee’s death or Disability, a portion of the Shares which on the date of termination of employment remain subject to a Time-Based Restriction and/or the Performance Restriction (as defined in Exhibit A) shall vest and become free of the forfeiture and transfer restrictions contained in the Agreement (except as otherwise provided in Section 2(b) of this Agreement).   The portion which shall vest shall be determined by the following formula (rounded to the nearest whole Share):

(A x B) - C, where
A = the total number of Shares granted under this Agreement,
B = the number of completed months to the date of termination of employment since the Effective Date of Grant divided by 36, and
C = the number of Shares granted under this Agreement which vested on or prior to the date of termination of employment. 

All Shares that are subject to a Period of Restriction on the date of termination of employment or service as a Director or Consultant and which will not be vested pursuant to Section 2(a)(ii) above, shall be forfeited to the Company, for no consideration.  

(iii)The term “Disability” shall have the meaning ascribed to such term in the Grantee’s employment, director services or similar agreement with the Company.  If the Grantee’s employment, director services or similar agreement does not define the term “Disability,” or if the Grantee has not entered into an employment, director services or similar agreement with the Company or any Subsidiary, the term “Disability” shall mean the Grantee’s entitlement to long-term disability benefits pursuant to the long-term disability plan maintained by the Company or in which the Company’s employees participate. 

(iv)If the Performance Restriction is not satisfied during the Measurement Period, all of the Shares that do not satisfy the performance criteria for the applicable Performance Period, shall be forfeited to the Company, for no consideration.

(b)  Transfer Restrictions.  During the Period of Restriction, the Restricted Stock may not be sold, assigned, pledged, exchanged, hypothecated or otherwise transferred, encumbered or disposed of, to the extent such Shares are subject to a Period of Restriction. 

(c)  Holding Period.   If and when (i) the Grantee is an Officer (as defined in Rule 16a-1(f) of the Exchange Act) or holds the title of President - Agency Operations, and (ii) Grantee does not hold Shares with a value sufficient to satisfy the applicable stock ownership guidelines of the Company in place at that time, then Grantee must retain 50% of the Shares acquired by Grantee as a result of the lapse of a Period of Restriction (excluding from the calculation any Shares withheld for purposes of satisfying Grantee’s tax obligations in connection with such lapse of a Period of Restriction) until such time as the value of the Shares remaining in Grantee’s possession following any sale, assignment, pledge, exchange, gift or other transfer of the Shares shall be sufficient to meet any applicable stock ownership guidelines of the Company in place at that time.  For the avoidance of doubt, at any time when Grantee holds, in the aggregate, Shares with a value sufficient to satisfy the applicable stock ownership guidelines of the Company in place at that time, Grantee may enter into a transaction with respect to any Shares acquired by Grantee as a result of the lapse of a Period of Restriction without regard to the holding period requirement contained in this Section 2(b) so long as Grantee shall continue to satisfy such stock ownership guidelines following such transaction.

(d)  Lapse of Restrictions.  The Period of Restriction shall lapse as to the Restricted Stock in accordance with the Notice of Restricted Stock Grant and the terms of this Agreement.  Subject to the terms of the Plan and Section 6(a) hereof, upon lapse of the Period of Restriction, the Grantee shall own the Shares that are subject to this Agreement free of all restrictions other than the holding period described in Section 2(c) above. Upon the occurrence of a Change in Control, unless otherwise specifically prohibited under applicable laws, or by the rules and regulations of any governing governmental agencies or national securities exchanges, any Period of Restriction or other restriction imposed on the Restricted Stock that has not previously lapsed, including the holding period described in Section 2(c) above, shall lapse.

		
	Section 3.  
	STOCK CERTIFICATES 

As soon as practicable following the grant of Restricted Stock, the Shares of Restricted Stock shall be registered in the Grantee’s name in certificate or book-entry form.  If a certificate is issued, it shall bear an appropriate legend referring to the restrictions and it shall be held by the Company, or its agent, on behalf of the Grantee until the Period of Restriction has lapsed.  If the Shares are registered in book-entry form, the restrictions shall be placed on the book-entry registration.  The Grantee may be required to execute and return to the Company a blank stock power for each Restricted Stock certificate (or instruction letter, with respect to Shares registered in book-entry form), which will permit transfer to the Company, without further action, of all or any portion of the Restricted Stock that is forfeited in accordance with this Agreement. 
		
	Section 4.  
	SHAREHOLDER RIGHTS

Except for the transfer and dividend restrictions, and subject to such other restrictions, if any, as determined by the Committee, the Grantee shall have all other rights of a holder of Shares, including the right to vote (or to execute proxies for voting) such Shares.  Unless otherwise determined by the Committee, 

if all or part of a dividend in respect of the Restricted Stock is paid in Shares or any other security issued by the Company, such Shares or other securities shall be held by the Company subject to the same restrictions as the Restricted Stock in respect of which the dividend was paid. 
		
	Section 5.  
	DIVIDENDS

(a)  Any dividends paid with respect to Shares which remain subject to a Period of Restriction shall not be paid to the Grantee but shall be held by the Company.

(b)  Such held dividends shall be subject to the same Period of Restriction as the Shares to which they relate.

(c)  Any dividends held pursuant to this Section 5 which are attributable to Shares which vest pursuant to this Agreement shall be paid to the Grantee within 30 days of the applicable vesting date.

(d)  Dividends attributable to Shares forfeited pursuant to Section 2 of this Agreement shall be forfeited to the Company on the date such Shares are forfeited.

		
	Section 6.  
	MISCELLANEOUS PROVISIONS

(a)  Tax Withholding.  Pursuant to Article 20 of the Plan, the Committee shall have the power and right to deduct or withhold, or require the Grantee to remit to the Company, an amount sufficient to satisfy any federal, state and local taxes (including the Grantee’s FICA obligations) required by law to be withheld with respect to this Award.  The Committee may condition the delivery of Shares upon the Grantee’s satisfaction of such withholding obligations.  The Grantee may elect to satisfy all or part of such withholding requirement by tendering previously-owned Shares or by having the Company withhold Shares having a Fair Market Value equal to the minimum statutory withholding (based on minimum statutory withholding rates for federal, state and local tax purposes, as applicable, including payroll taxes) that could be imposed on the transaction, and, to the extent the Committee so permits, amounts in excess of the minimum statutory withholding to the extent it would not result in additional accounting expense.  Such election shall be irrevocable, made in writing, signed by the Grantee, and shall be subject to any restrictions or limitations that the Committee, in its sole discretion, deems appropriate. 
(b)  Ratification of Actions.  By accepting this Agreement, the Grantee and each person claiming under or through the Grantee shall be conclusively deemed to have indicated the Grantee’s acceptance and ratification of, and consent to, any action taken under the Plan or this Agreement and Notice of Restricted Stock Grant by the Company, the Board or the Committee. 

(c)  Notice.  Any notice required by the terms of this Agreement shall be given in writing and shall be deemed effective upon personal delivery or upon deposit with the United States Postal Service, by registered or certified mail, with postage and fees prepaid.  Notice shall be addressed to the Company at its principal executive office and to the Grantee at the address that he or she most recently provided in writing to the Company. 

(d)  Choice of Law.  This Agreement and the Notice of Restricted Stock Grant shall be governed by, and construed in accordance with, the laws of Florida, without regard to any conflicts of law or choice of law rule or principle that might otherwise cause the Plan, this Agreement or the Notice of Restricted Stock Grant to be governed by or construed in accordance with the substantive law of another jurisdiction. 

(e)  Arbitration.  Subject to, and in accordance with the provisions of Article 3 of the Plan, any dispute or claim arising out of or relating to the Plan, this Agreement or the Notice of Restricted Stock Grant shall be settled by binding arbitration before a single arbitrator in Jacksonville, Florida and in accordance with the Commercial Arbitration Rules of the American Arbitration Association.  The arbitrator shall decide any issues submitted in accordance with the provisions and commercial purposes of the Plan, this Agreement and the Notice of Restricted Stock Grant, provided that all substantive questions of law shall be determined in accordance with the state and federal laws applicable in Florida, without regard to internal principles relating to conflict of laws. 

(f)  Modification or Amendment.  This Agreement may only be modified or amended by written agreement executed by the parties hereto; provided, however, that the adjustments permitted pursuant to Section 4.3 of the Plan may be made without such written agreement. 

(g)  Severability.  In the event any provision of this Agreement shall be held illegal or invalid for any reason, the illegality or invalidity shall not affect the remaining provisions of this Agreement, and this Agreement shall be construed and enforced as if such illegal or invalid provision had not been included. 

(h)  References to Plan.  All references to the Plan shall be deemed references to the Plan as may be amended from time to time. 

(i)  Section 409A Compliance.  To the extent applicable, it is intended that the Plan and this Agreement comply with the requirements of Code Section 409A and any related regulations or other guidance promulgated with respect to such Section by the U.S.  Department of the Treasury or the Internal Revenue Service and the Plan and the Award Agreement shall be interpreted accordingly.

EXHIBIT A
Vesting and Restrictions

This grant is subject to both a Performance Restriction and a Time-Based Restriction, as described below (collectively, the “Period of Restriction”). 

Performance Restriction

In order for the Restricted Stock to vest, the Compensation Committee of the Board of Directors of the Company (the “Committee”) must determine that the Company has achieved 8.5% or greater Title Operating Margin (as defined below) in at least two calendar quarters of any of the next five calendar quarters starting October 1, 2018 (the “Performance Restriction”). The five calendar quarters starting October 1, 2018 and ending December 31, 2019 are referred to as the “Measurement Period.” “Title Operating Margin” shall mean the Title Pre-Tax Margin as used for the annual bonus plan.  Calculation of Title Operating Margin will exclude claim loss reserve adjustments (positive or negative) for prior period loss development, extraordinary events or accounting adjustments, acquisitions, divestitures, major restructuring charges, and non-budgeted discontinued operations. The Committee will evaluate whether the Title Operating Margin has been achieved following the completion of each calendar quarter during the Measurement Period. 

Time-Based Restrictions

	
		
	Anniversary Date
	% of Restricted Stock 

	First (1st) anniversary of the Effective Date of Grant
	33.33%

	Second (2nd) anniversary of the Effective Date of Grant
	33.33%

	Third (3rd) anniversary of the Effective Date of Grant
	33.34%

Vesting

If the Performance Restriction has been achieved as of an Anniversary Date, the percentage of the Restricted Stock indicated next to such Anniversary Date shall vest on such indicated Anniversary Date (such three year vesting schedule referred to as the “Time-Based Restrictions”). If the Performance Restriction has not been achieved as of an Anniversary Date, but is achieved on or before the end of the Measurement Period, then the percentage of the Restricted Stock indicated next to such Anniversary Date shall vest at such time as the Committee determines that the Company has achieved the Performance Restriction. If the Performance Restriction is not achieved during the Measurement Period, none of the Restricted Stock granted hereunder shall vest and, for no consideration, will be automatically forfeited to the Company.Exhibit 10.1

 

Subscription Agreement

 

This subscription agreement
(this “Subscription”) is dated February 13, 2019, by and between the investor identified on the signature page
hereto (the “Investor”) and Chicken Soup for the Soul Entertainment, Inc., a Delaware corporation (the “Company”),
whereby the parties agree as follows:

 

WHEREAS, the Company
desires to sell, and the Investor desires to purchase shares of the Company’s 9.75% Series A cumulative redeemable preferred
stock (“Series A Preferred Stock”).

 

NOW, THEREFORE, in
consideration of the mutual agreements contained herein, the parties hereto agree as follows:

 

1.            Subscription.

 

(a)           Investor agrees to buy and, subject to acceptance as provided below, the Company agrees to sell and issue to Investor, such
number of shares (the “Shares”) of the Series A Preferred Stock as are set forth on the signature page hereto,
for the aggregate purchase price set forth on the signature page hereto (the “Purchase Price”).

 

(b)           The Shares have been registered pursuant to a Registration Statement on Form S-3, Registration No. 333-227596, which registration
statement (the “Registration Statement”) has been declared effective by the Securities and Exchange Commission
and is effective on the date hereof. A final prospectus supplement will be delivered as required by law.

 

(c)           The Company may accept this Subscription at any time for all or any portion of the Shares subscribed for by executing a
copy hereof as provided and notifying the Investor within a reasonable time thereafter. The Company has the right to reject this
subscription for the Series A Preferred Stock, in whole or in part for any reason and at any time prior to the Closing (as defined
below) thereon, notwithstanding prior receipt by the Investor of notice of acceptance of the Investor’s subscription. In
the event the Investor’s subscription is rejected, the Investor’s payment will be returned from escrow promptly to
the Investor without interest or deduction and this Subscription will have no force or effect. The Shares subscribed for herein
will not be deemed issued to or owned by the Investor until one copy of this Subscription has been executed by the Investor and
countersigned by the Company and the Closing with respect to the Investor’s subscription has occurred.

 

(d)           Provided that the full Purchase Price and a completed and manually executed copy of this Subscription have been tendered
and not returned in accordance with Section 2, the closing of Investor’s purchase of the Shares shall occur on or prior to
February 13, 2019, which date may be extended by up to five business days by the Company without notice to the Investor (such date,
as may be extended, the “Closing Date”). Promptly thereafter, the Company shall cause the Shares to be delivered
to the Investor, which delivery shall be made by delivery of physical certificates to Investor, or if so designated, through the
facilities of The Depository Trust Company’s DWAC system in accordance with the instructions set forth on the Investor’s
signature page attached hereto under the heading “DWAC Instructions.”

 

2.            Investor Delivery of Documents and Payment. The Investor hereby tenders to the Company (i) the full Purchase Price
by check or wire transfer and (ii) one completed and manually executed copy of this Subscription. In the event that the sale of
Shares are not consummated for any reason, the Purchase Price will be returned to the investor without interest or deduction.

 

     

     

    

 

3.            Company
Representations and Warranties.  The Company represents and warrants that: (a) it has full corporate power and authority
to enter into this Subscription and to perform all of its obligations hereunder; (b) this Subscription has been duly authorized
and executed by and, when delivered in accordance with the terms hereof, will constitute a valid and binding agreement of the
Company enforceable in accordance with its terms, except as such enforceability may be limited by bankruptcy, insolvency, reorganization,
moratorium or similar laws affecting the rights and remedies of creditors generally or subject to general principles of equity;
(c) the execution and delivery of this Subscription and the consummation of the transactions contemplated hereby do not conflict
with or result in a breach of (i) the Company’s Amended and Restated Certificate of Incorporation (including the Certificate
of Designations of the Series A Preferred Stock) or Bylaws, or (ii) any material agreement to which the Company is a party or
by which any of its property or assets is bound; (d) the Shares when issued and paid for in accordance with the terms of this
Subscription will be duly authorized, validly issued, fully paid and non-assessable; (e) the Registration Statement and any post-effective
amendment thereto, at the time it became effective, did not contain any untrue statement of a material fact or omit to state a
material fact required to be stated therein or necessary to make the statements therein not misleading; (f) the prospectus contained
in the Registration Statement, as amended or supplemented, did not contain as of the effective date thereof, and as of the date
hereof does not contain, any untrue statement of a material fact or omit to state a material fact necessary in order to make the
statements therein, in light of the circumstances under which they were made, not misleading; and (g) all preemptive rights or
rights of first refusal held by stockholders of the Company and applicable to the transactions contemplated hereby have been duly
satisfied or waived in accordance with the terms of the agreements between the Company and such stockholders conferring such rights.

 

4.            Investor Representations, Warranties and Acknowledgments. 

 

(a)           The
Investor represents and warrants that: (i) it has full right, power and authority to enter into this Subscription and to perform
all of its obligations hereunder; (ii) this Subscription has been duly authorized and executed by the Investor and , when delivered
in accordance with the terms hereof, will constitute a valid and binding agreement of the Investor enforceable against the Investor
in accordance with its terms, except as such enforceability may be limited by bankruptcy, insolvency, reorganization, moratorium
or similar laws affecting the rights and remedies of creditors generally or subject to general principles of equity; (iii) the
execution and delivery of this Subscription and the consummation of the transactions contemplated hereby do not conflict with
or result in a breach of (A) the Investor’s certificate of incorporation or by-laws (or other governing documents), or (B)
any material agreement or any law or regulation to which the Investor is a party or by which any of its property or assets is
bound; (iv) it has had full access to the base prospectus included in the Registration Statement and the Company’s periodic
reports and other information incorporated by reference therein, and was able to read, review, download and print such materials;
(v) in making its investment decision in this offering, the Investor and its advisors, if any, have relied solely on the Company’s
public filings with the Securities and Exchange Commission; (vi) it is knowledgeable, sophisticated and experienced in making,
and is qualified to make, decisions with respect to investments in securities representing an investment decision like that involved
in the purchase of the Shares; and (vii) except as set forth below, the Investor is not a, and it has no direct or indirect affiliation
or association with any, National Association of Securities Dealers, Inc. member as of the date hereof.

 

	Exceptions:
	 
	 

(If no exceptions, write
“none.” If left blank, response will be deemed to be “none.”)

 

(b)           The Investor also represents and warrants that, other than the transactions contemplated hereunder, the Investor has not
directly or indirectly, nor has any person acting on behalf of or pursuant to any understanding with the Investor, executed any
disposition, including “short sales” as defined in Rule 200 of Regulation SHO under the Securities Exchange Act of
1934 (the “Short Sales”), in the securities of the Company during the period commencing from the time that the
Investor first became aware of the proposed transactions contemplated hereunder until the date hereof (“Discussion Time”).
The Investor has maintained the confidentiality of all disclosures made to it in connection with this transaction (including the
existence and terms of this transaction).

 

    2

     

    

 

5.            Investor
Covenant Regarding Short Sales and Confidentiality. The Investor covenants that neither it nor any affiliates acting on its
behalf or pursuant to any understanding with it will execute any Short Sales or other disposition of securities of the Company
during the period after the Discussion Time and ending at the time that the transactions contemplated by this Subscription are
first publicly announced through a press release and/or Form 8-K. The Investor covenants that until such time as the transactions
contemplated by this Subscription are publicly disclosed by the Company through a press release and/or Form 8-K, the Investor
will maintain the confidentiality of all disclosures made to it in connection with this transaction (including the existence and
terms of this transaction).

 

6.            Miscellaneous.

 

(a)           The Company will reimburse Investor $50,000 for due diligence fees in connection with this transaction. This Subscription
constitutes the entire understanding and agreement between the parties with respect to its subject matter, and there are no agreements
or understandings with respect to the subject matter hereof which are not contained in this Subscription. This Subscription may
be modified only in writing signed by the parties hereto.

 

(b)           This Subscription may be executed in any number of counterparts, all of which taken together shall constitute one and the
same instrument and shall become effective when counterparts have been signed by each party and delivered to the other parties
hereto, it being understood that all parties need not sign the same counterpart.  Execution may be made by delivery by facsimile.

 

(c)           The provisions of this Subscription are severable and, in the event that any court or officials of any regulatory agency
of competent jurisdiction shall determine that any one or more of the provisions or part of the provisions contained in this Subscription
shall, for any reason, be held to be invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability
shall not affect any other provision or part of a provision of this Subscription and this Subscription shall be reformed and construed
as if such invalid or illegal or unenforceable provision, or part of such provision, had never been contained herein, so that such
provisions would be valid, legal and enforceable to the maximum extent possible, so long as such construction does not materially
adversely effect the economic rights of either party hereto.

 

(d)           All communications hereunder, except as may be otherwise specifically provided herein, shall be in writing and shall be
mailed, hand delivered, sent by a recognized overnight courier service such as Federal Express, or sent via facsimile and confirmed
by letter, to the party to whom it is addressed at the following addresses or such other address as such party may advise the other
in writing:

 

 

To the Seller: 
as set forth on the signature page hereto.

 

To the Buyer:  as
set forth on the signature page hereto.

 

All notices hereunder shall be effective
upon receipt by the party to which it is addressed.

 

(e)           This Subscription shall be governed by and interpreted in accordance with the laws of the State of Connecticut for contracts
to be wholly performed in such state and without giving effect to the principles thereof regarding the conflict of laws. 
To the extent determined by such court, the prevailing party shall reimburse the other party for any reasonable legal fees and
disbursements incurred in enforcement of, or protection of any of its rights under this Subscription.

 

    3

     

    

 

If the foregoing correctly
sets forth our agreement, please confirm this by signing and returning to us the duplicate copy of this Subscription.

 

	 	 	CHICKEN SOUP FOR THE SOUL ENTERTAINMENT, INC. 
	 	 	 	 
	 	 	 	 
	 	 	By:  	 /s/ William J. Rouhana, Jr.
	 	 	 	Name: William J. Rouhana, Jr.
	
        Number of Shares: 40,000

         

        Purchase Price Per Share: $25.00

         

        Aggregate Purchase Price:
        $1,000,000
	 	 	
        Title: Chief Executive Officer

        

Address for Notice:

         

        Chicken Soup for the Soul Entertainment, Inc.

        132 E. Putnam Avenue, Floor 2W

        Cos Cob, Connecticut 06807

        Facsimile: [( )_____]

        Attention: Chief Executive Officer

	 	 	 	 
	 	 	 	 
	INVESTOR: DAVID S. NAGELBERG 2003 REVOCABLE TRUST
	 	 	 	 
	By:  	/s/ David S. Nagelberg	 	 	 
	Name: David S. Nagelberg	 	 	 
	Title: Trustee	 	 	 
	 	 	 	 
	Address for Notice:	 	 	 
	939 Coast Blvd., Unit 21 DE	 	 	 
	La Jolla, CA 92037	 	 	 
	 	 	 	 
	Facsimile: 858-750-2348	 	 	 
	Attention: David S. Nagelberg	 	 	 
	 	 	 	 
	DWAC Instructions:	 	 	 
	 	 	 	 
	Name of DTC Participant (broker-dealer at which the account or accounts to be credited with the Shares are maintained):	 	 	 
	 	 	 	 
	DTC Participant Number:	 	 	 
	 	 	 	 
	Name of Account at DTC Participant
being credited with the Shares:	 	 	 
	 	 	 	 
	Account Number at DTC Participant
being credited with the Shares:	 	 	 

 

    4

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