Document:

Form of $1,750,000,000 Floating Rate Note Due June 15, 2012

 Exhibit 4.2 
 [Face of Note] 
 Unless this certificate is presented by an authorized representative of The Depository
Trust Company, a New York corporation (“DTC”), to the Issuer 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. 
 This debt is guaranteed under the FDIC
Temporary Liquidity Guarantee Program and is backed by the full faith and credit of the United States. The details of the FDIC guarantee are provided in the FDIC’s regulations, 12 C.F.R. Part 370, and at the FDIC’s website,
www.fdic.gov/tlgp. The expiration date of the FDIC’s guarantee is the earlier of the maturity date of this debt or June 30, 2012. 
  

			
	CUSIP NO.             	  	PRINCIPAL AMOUNT: $            
	CLEARSTREAM COMMON CODE             	  	
	ISIN             	  	
	REGISTERED NO.     	  	

 WELLS FARGO & COMPANY 
 Floating Rate Notes Due June 15, 2012 
 WELLS FARGO & COMPANY, a
corporation duly organized and existing under the laws of the State of Delaware (hereinafter called the “Company,” which term includes any successor corporation under the Indenture hereinafter referred to), for value received, hereby
promises to pay to CEDE & Co., or registered assigns, the principal sum of
                    ($                    ) 
on June 15, 2012 (the “Stated Maturity Date”) and to pay interest thereon from March 30, 2009 or from the most recent Interest Payment Date (as defined below) to which interest has been paid or duly provided for on the dates and
at the rate set forth below, until the principal hereof is paid or made available for payment. The interest so payable, and punctually paid or duly provided for, on any Interest Payment Date will, as provided in the Indenture, be paid to the Person
in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest (whether or not a Business Day, as defined below) next preceding such Interest Payment Date. The
Regular Record Date for an Interest Payment Date shall be the fifteenth calendar day, whether or not a Business Day, prior to such Interest Payment Date. 
 The interest rate per annum for this Security will be equal to LIBOR Reuters (as defined below) plus 0.22%, as determined by the calculation agent for this Security (the “Calculation Agent”), and will be
reset quarterly on each March 15, June 15, September 15 and December 15, 

 
commencing June 15, 2009. Each of these dates on which interest will be reset shall be referred to as an “Interest Reset Date.” The initial
interest rate per annum for this Security will be equal to LIBOR Reuters plus 0.22%, as determined two London Banking Days (as defined below) prior to March 30, 2009 by the Calculation Agent. 
 Interest on this Security will be paid on each March 15, June 15, September 15 and December 15, commencing June 15,
2009, and at Maturity. Each of these dates on which interest will be paid is referred to as an “Interest Payment Date.” If an Interest Payment Date would fall on a day that is not a Business Day, other than the Interest Payment Date that
is also the date of Maturity, such Interest Payment Date will be postponed to the following day that is a Business Day; provided, however, if such next Business Day is in a different month, then interest on this Security shall be paid on the
Business Day immediately preceding such Interest Payment Date. If the date of Maturity would fall on a day that is not a Business Day, the payment of principal and any premium and interest shall be made on the next Business Day, with the same force
and effect as if made on the due date, and no additional interest shall accrue on the amount so payable for the period from and after such date of Maturity. “Business Day” as used herein means 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 or Minneapolis, Minnesota. 
 Except as described below for the first Interest Period, on each Interest Payment Date, the Company will pay interest for the period commencing on and
including the immediately preceding Interest Payment Date and ending on and including the next day preceding that Interest Payment Date. This period is referred to as an “Interest Period.” The first Interest Period will begin on and
include March 30, 2009 and, subject to the immediately preceding paragraph, will end on and include June 14, 2009. The amount of interest to be paid on this Security for each Interest Period will be calculated by multiplying the principal
amount of this Security by an accrued interest factor. The “accrued interest factor” will be computed by adding the interest factors calculated for each day in the Interest Period. The “interest factor” for each day is computed
by dividing the interest rate applicable to that day by 360. 
 “LIBOR Reuters,” for any Interest Determination Date (as defined
below) shall be the arithmetic mean of the offered rates for deposits in United States dollars having a three-month maturity, commencing on the second London Banking Day immediately following that Interest Determination Date, that appear on Reuters
Page LIBOR01 (as defined below) as of 11:00 a.m., London time, on that Interest Determination Date if at least two offered rates appear on Reuters Page LIBOR01; provided that if Reuters Page LIBOR01 by its terms provides only for a single rate, that
single rate will be used to determine LIBOR Reuters. If fewer than two offered rates appear, or no rate appears and Reuters Page LIBOR01 by its terms provides only for a single rate, then the Calculation Agent will request the principal London
offices of each of four major banks in the London interbank market, as selected by the Calculation Agent, to provide the Calculation Agent with its offered quotation for deposits in United States dollars for a three-month period commencing on the
second London Banking Day immediately following the Interest Determination Date to prime banks in the London interbank market at approximately 11:00 a.m., London time, on that Interest Determination Date in a Representative Amount (as defined
below). If at least two 

  

 2 

 
quotations are provided, LIBOR Reuters determined on that Interest Determination Date will be the arithmetic mean of those quotations. If fewer than two
quotations are provided, LIBOR Reuters will be determined for the applicable Interest Reset Date as the arithmetic mean of the rates quoted at approximately 11:00 a.m., New York City time, by three major banks in New York City selected by the
Calculation Agent for loans in U.S. dollars to leading European banks, having a three-month maturity and in a Representative Amount. If the banks so selected by the Calculation Agent are not quoting as set forth above, LIBOR Reuters for that
Interest Determination Date will remain LIBOR Reuters for the immediately preceding Interest Period, or, if none, the rate of interest payable will be the initial interest rate. 
 “Interest Determination Date” means, for any Interest Reset Date, the second London Banking Day prior to that Interest Reset Date. 

“London Banking Day” means any day on which dealings in deposits in U.S. dollars are transacted in the London interbank market. 

“Representative Amount” means a principal amount that is representative for a single transaction in U.S. dollars in the relevant market at
the relevant time. 
 “Reuters Page LIBOR01” means the display designated as “Page LIBOR01” on Reuters Money 3000 Service
or any successor service (or such other page as may replace Page LIBOR01 on that service or a successor service). 
 All percentages used in
or resulting from any of the above calculations will be rounded, if necessary, to the nearest one hundred-thousandth of a percentage point, with .000005% rounded up to .00001%, and all U.S. dollar amounts used in or resulting from any of the above
calculations will be rounded, if necessary, to the nearest cent, with one-half cent rounded upward. 
 The interest rate on the Securities of
this series will in no event be higher than the maximum rate permitted by New York law as the same may be modified by United States law of general application. 
 The Calculation Agent shall, upon the request of a Holder of this Security, provide the interest rate then in effect and, if determined, the interest rate that will become effective on the next Interest Reset Date.
All calculations of the Calculation Agent, in the absence of manifest error, shall be conclusive for all purposes and binding on the Company and the Holder hereof. The Calculation Agent shall notify the Paying Agent of each determination of the
interest applicable to this Security promptly after the determination is made. Wells Fargo Bank, N.A. will initially act as Calculation Agent. The Company may appoint a successor Calculation Agent with the written consent of the Paying Agent, which
consent shall not be unreasonably withheld. 
 Any interest not punctually paid or duly provided for will forthwith cease to be payable to
the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on a Special Record Date for the payment of such Defaulted
Interest to be fixed by the Trustee, notice whereof shall be given to Holders of Securities of this series not less than 10 days prior to such Special 

  

 3 

 
Record Date, or be paid at any time in any other lawful manner not inconsistent with the requirements of any securities exchange on which the Securities of
this series may be listed, and upon such notice as may be required by such exchange, all as more fully provided in the Indenture. 
 Payment
of interest on this Security will be made in immediately available funds at the office or agency of the Company maintained for that purpose in the City of Minneapolis, Minnesota 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; provided, however, that, at the option of the Company, payment of interest may be paid by check mailed to the Person entitled thereto at such Person’s last address as it
appears in the Security Register or by wire transfer to such account as may have been designated by such Person. Payment of principal of and interest 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. Notwithstanding the foregoing, for so long as this Security is a Global Security registered in the name of the Depositary, payments of principal and interest on
this Security will be made to the Depositary by wire transfer of immediately available funds. 
 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. 
 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. 
  

 4 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed under its corporate seal.

 DATED: March 30, 2009 
  

			
	WELLS FARGO & COMPANY
		
	By:	 	  

		 	Barbara S. Brett, Senior Vice President and
		 	Assistant Treasurer

 [SEAL] 
  

			
	Attest:	 	  

		 	Laurel A. Holschuh, Senior Vice President and Secretary

 TRUSTEE’S CERTIFICATE OF 
 AUTHENTICATION 
 This is one of the Securities of the 
 series designated therein referred to 
 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

  

 5 

 [Reverse of Note] 
 WELLS FARGO & COMPANY 
 Floating Rate Notes Due June 15, 2012 
 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 July 21, 1999, as amended by the Fourth Supplemental Indenture dated as of December 10, 2008 and as further amended or supplemented from time to time (herein called the “Indenture”),
between the Company 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 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 designated on the face hereof, limited in aggregate principal amount to $                    ; provided, however,
that the Company may, so long as no Event of Default has occurred and is continuing with respect to the Securities of this series, without the consent of the Holders of the Securities of this series, issue additional Securities with the same terms
as the Securities of this series, and such additional Securities shall be considered part of the same series under the Indenture as the Securities of this series. 
 Pursuant to the Fourth Supplemental Indenture dated as of December 10, 2008, the Company and Trustee acknowledged that the Company has not opted out of the debt guarantee program (the “Debt Guarantee
Program”) established by the Federal Deposit Insurance Corporation (the “FDIC”) under the Temporary Liquidity Guarantee Program on November 21, 2008 pursuant to the FDIC’s Final Rule, 12 C.F.R. Part 370 (as may be
amended or supplemented from time to time, the “Rule”). The Trustee and its successors are designated as the duly authorized representatives (the “Representative”) of the Holders of the Securities of this series for purposes of
making claims and taking other permitted or required actions under the Debt Guarantee Program. Any such Holder may elect not to be represented by the Representative by providing written notice of such election to the Representative (it being
understood that such election shall not affect the Trustee’s capacity under the Indenture except as the representative of such Holder under the Debt Guarantee Program). 
 Upon an uncured failure by the Company to make a timely payment of principal or interest under the Securities of this series (a “Payment
Default”), the Representative, on behalf of all Holders of the Securities of this series that are represented by the Representative, shall submit to the FDIC a demand for payment by the FDIC of such unpaid principal and interest, together with
proof of such claim and such other documentation as may be required by the FDIC under the Rule (i) in the case of any Payment Default prior to the Stated Maturity Date, promptly, and 

  

 6 

 
in no event later than the earlier of the end of the applicable cure period and 60 days following such Payment Default and (ii) in the case of any
payment due on the Stated Maturity Date, on such Stated Maturity Date. 
 The FDIC shall be subrogated to all of the rights of the Holders of
the Securities of this series and the Representative with respect to the Securities of this series under the Indenture against the Company in respect of any amounts paid to the Holders of the Securities of this series, or for the benefit of the
Holders of the Securities of this series, by the FDIC pursuant to the Debt Guarantee Program. 
 The Holders of Securities of this series, by
their acceptance of the Securities of this series, authorize the Representative, at such time as the FDIC shall commence making any guarantee payments to the Representative for the benefit of the Holders of the Securities of this series pursuant to
the Debt Guarantee Program (each, a “Guarantee Payment”), to execute an assignment in the form attached hereto as Annex A, pursuant to which the Representative shall assign to the FDIC its right as Representative to receive any and
all payments from the Company under the Indenture on behalf of the Holders of the Securities of this series. The Company hereby consents and agrees that the FDIC is an acceptable transferee for all or any portion of the Securities of this series for
all purposes of the Indenture and upon any such assignment, the FDIC shall be deemed a Holder of the Securities of this series under the Indenture for all purposes thereof, and the Company hereby agrees to take such reasonable steps as are necessary
to comply with any relevant provision of the Indenture as a result of such assignment. 
 If a Holder of the Securities of this series has
exercised its right not to be represented by the Representative, such Holder, by its acceptance of the Securities of this series, agrees that, at such time as the FDIC shall commence making any Guarantee Payments to such Holder pursuant to the Debt
Guarantee Program, such Holder shall execute an assignment in the form attached hereto as Annex A, pursuant to which such Holder shall assign to the FDIC its right to receive any and all payments from the Company with respect to the Securities
of this series under the Indenture. 
 If, at any time on or prior to the expiration of the Effective Period, payment in full hereunder shall
be made pursuant to the Debt Guarantee Program on the outstanding principal and accrued interest to such date of payment, the Holder of this Security shall, or shall cause the person or entity in possession of this Security to, promptly surrender to
the FDIC the security certificate, note or other instrument evidencing this Security. 
 The Securities of this series are not subject to
redemption at the option of the Company or repayment at the option of the Holder hereof prior to June 15, 2012. The Securities of this series will not be entitled to any sinking fund. 
 There shall not be deemed to be an Event of Default under the Securities of this series which would permit or result in the acceleration of amounts due
under the Securities of this series, if such an Event of Default is due solely to the failure of the Company to make timely payment on the Securities of this series provided that the FDIC is making timely Guarantee Payments with respect to such
Securities in accordance with the Rule. Subject to the foregoing, 

  

 7 

 
if an Event of Default, as defined in the Indenture, with respect to Securities of this series shall occur and be continuing, the principal of the Securities
of this series may be declared due and payable in the manner and with the effect provided in the Indenture. 
 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 rights of the Holders of the Securities of each series to be affected under the Indenture at any time by the
Company 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. 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, on behalf of the Holders of all Securities of such series, to waive compliance by the Company 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. 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. Without the express written consent of the FDIC, the Company and the Trustee have agreed not to
amend, modify, supplement or waive any provision in the Indenture that is related to the principal, interest, payment, default or ranking of the Securities of this series, that is required to be included in the Indenture pursuant to the Master
Agreement or the amendment of which would require the consent of the Holders of all of the Securities of this series. 
 The Indenture
contains provisions for defeasance at any time of (a) the entire indebtedness on this Security and (b) certain restrictive covenants and certain Events of Default, upon compliance by the Company with certain conditions set forth therein, which
provisions apply to this Security. 
 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 in authorized denominations for an equal aggregate principal 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 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, bearing
interest at the same rate, having the same date of issuance, redemption provisions, Stated Maturity Date and other terms and of authorized denominations aggregating a like amount. 
  

 8 

 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. 
 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 principal of and interest on this Security at the times, place and rate, and in the coin or currency, herein prescribed, except as otherwise provided in this Security and except that in the event the Company
deposits money or Eligible Instruments as provided in Articles 4 and 15 of the Indenture, such payments will be made only from proceeds of such money or Eligible Instruments. 
 Prior to due presentment of this Security for registration of transfer, the Company, the Trustee and any agent of the Company 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 Trustee nor any such agent shall be affected by notice to the contrary. 
 No recourse shall be had for the payment of the principal of or the interest on this Security, 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, 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.

 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. 
  

 9 

 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) 

 the within Security of WELLS FARGO & COMPANY 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. 
  

	
	  
	Signature Guarantee

  

 11 

 ANNEX A 
 ASSIGNMENT 
 This Assignment is made pursuant to the terms of the Floating Rate Notes due June 15, 2012
(CUSIP No.             ) (the “Note”) and Section 16.04 of the Indenture, dated as of July 21, 1999, as amended from time to time (the “Indenture”),
between Citibank, N.A. (the “Representative”), acting on behalf of the Holders of the Guaranteed Securities issued under the Indenture who have not opted out of representation by the Representative (with those Holders of Guaranteed
Securities who have opted out of representation by the Representative being the “Unrepresented Holders”), and Wells Fargo & Company (the “Issuer”) with respect to the Note. Capitalized terms used herein and not otherwise
defined herein shall have the meanings assigned thereto in the Indenture. 
 For value received, [the Representative, on behalf of the
Holders of Guaranteed Securities] [OR] [the Unrepresented Holders] (the “Assignor”), hereby assigns to the Federal Deposit Insurance Corporation (the “FDIC”), without recourse, all of the Assignor’s respective rights, title
and interest in and to: (a) the Note; (b) the Indenture, with respect to the Note; and (c) any other instrument or agreement executed by the Issuer regarding obligations of the Issuer under the Note or the Indenture, with respect to
the Note (collectively, the “Assignment”). 
 The Assignor hereby certifies that: 
 1. Without the FDIC’s prior written consent, the Assignor has not: 
 (a) agreed to any material amendment of the Note or the Indenture to the extent relating to the Note or to any material deviation from the provisions thereof; or 
 (b) accelerated the maturity of the Note. 
 [Instructions to
the Assignor: If the Assignor has not assigned or transferred any interest in the Note and related documentation, such Assignor must include the following representation.] 
 2. The Assignor has not assigned or otherwise transferred any interest in the Note or Indenture to the extent relating to the Note; 
 [Instructions to the Assignor: If the Assignor has assigned a partial interest in the Note and related documentation, the Assignor must include the following
representation.] 
 2. The Assignor has assigned part of its rights, title and interest in the Note and the Indenture to the extent relating
to the Note to              pursuant to the              agreement, dated as of
            , 20     between             , as assignor, and
            , as assignee, an executed copy of which is attached hereto. 
  

 Annex A-1 

 The Assignor acknowledges and agrees that this Assignment is subject to the Indenture and to the
following: 
 1. In the event the Assignor receives any payment under or related to the Note or the Indenture, with respect to the Note, from
a party other than the FDIC (a “Non-FDIC Payment”): 
 (a) after the date of demand for a Guarantee Payment on the FDIC pursuant to
the Rule, but prior to the date of the FDIC’s first Guarantee Payment under the Note or the Indenture, with respect to the Note, pursuant to the Rule, the Assignor shall promptly but in no event later than five (5) Business Days after
receipt notify the FDIC of the date and the amount of such Non-FDIC Payment and shall apply such payment as payment made by the Issuer, and not as a Guarantee Payment made by the FDIC, and therefore, the amount of such payment shall be excluded from
this Assignment; and 
 (b) after the FDIC’s first Guarantee Payment under the Note or the Indenture, with respect to the Note, the
Assignor shall forward promptly to the FDIC such Non-FDIC Payment in accordance with the payment instructions provided in writing by the FDIC. 
 2. Acceptance by the Assignor of payment pursuant to the Debt Guarantee Program on behalf of the Holders of Guaranteed Securities shall constitute a release by such Holders of any liability of the FDIC under the Debt Guarantee Program with
respect to such payment. 
 The Person who is executing this Assignment on behalf of the Assignor hereby represents and warrants to the FDIC
that he/she/it is duly authorized to do so. 
 IN WITNESS WHEREOF, the parties hereto have caused this Assignment to be duly executed and
attested, all as of this             day of             ,     . 
  

			
	[CITIBANK, N.A.,
	REPRESENTATIVE]
	[OR]
	[UNREPRESENTED HOLDER]
		
	By:	 	  

	Name:	 	
	Title:	 	

  

 Annex A-2 

			
	 Attest:
	 	
		
	 By:
	 	  

	 Name:
	 	

 Consented to and acknowledged by this 
              day of             , 20     
 THE FEDERAL DEPOSIT INSURANCE 
 CORPORATION 
  

					
	By:	 	  
	 	
		 	(Signature)	 	
			
	Name:	 	  
	 	
		 	(Print)	 	
			
	Title:	 	  
	 	
		 	(Print)	 	

  

 Annex A-3Amended Form of Performance Share Agreement

 Exhibit 10.1 
 ATRICURE, INC. 
 2005 EQUITY INCENTIVE PLAN 
 PERFORMANCE SHARE AGREEMENT 
 As
Amended on March 26, 2009 
 Summary of Performance Share Grant 
 AtriCure, Inc., a Delaware corporation (the “Company”), grants to the Grantee named below, in accordance with the terms of the 2005 Equity Incentive Plan (the “Plan”) and this Performance Share
Agreement (the “Agreement”), Performance Shares as follows: 
  

					
	 Name of Grantee:
	 	  
	 	
			
	Maximum Number of Performance Shares:	 	  
	 	
			
	Grant Date:	 	  
	 	
			
	Performance Goals:	 	As set forth on Exhibit A 	 	
			
	Performance Period:	 	As set forth on Exhibit A 	 	

 Terms of Agreement 
 1. Grant of Performance Shares. Subject to and upon the terms, conditions, and restrictions set forth in this Agreement and in the Plan, the Company grants to the Grantee as of the Grant Date, Performance
Shares upon the terms and conditions of this Agreement. Each Performance Share shall represent one hypothetical Share and shall at all times be equal in value to one Share. 
 2. Earning of Performance Shares. 
 (a) Except as provided in Section 3, Performance Shares shall be earned as set forth on Exhibit A, provided that the Grantee has remained continuously employed by the Company or any Subsidiary from the Grant Date through the end of the
Performance Period. 
 (b) Prior to the payment of any Performance Shares as provided in this Agreement, the Committee shall determine in
writing the extent, if any, that the Performance Goals have been satisfied and shall determine the number, if any, of Performance Shares that shall have become earned under this Agreement. The Committee may in its sole discretion modify the
Performance Goals, in whole or in part, as the Committee deems appropriate and equitable to reflect a change in the business, operations, corporate structure or capital structure of the Company or its Subsidiaries, the manner in which it conducts
its business, or other events or circumstances. 
 3. Payment of Performance Shares. 
 (a) Except as otherwise provided in this Section 3, if and to the extent earned pursuant to Section 2 above, the Company shall deliver to the
Grantee the Shares underlying the earned Performance Shares in one installment to be delivered within 90 days of December 31, 2010. Except as otherwise provided in Section 3(b) or 3(c) or as otherwise provided by the Committee, the Grantee
must be employed by the Company or a Subsidiary on December 31, 2010 in order to be entitled to payment of any such Shares. 

 (b) If the Grantee’s continuous employment with the Company and its Subsidiaries terminates due to a
permanent and total disability (a “Permanent Disability”) within the meaning of Section 22(e)(3) of the Code, the Grantee’s employment with the Company and its Subsidiaries shall, for all purposes under this Agreement, be deemed
to continue. If Grantee dies while suffering a Permanent Disability, Grantee’s estate shall have the rights to Shares underlying Performance Shares on the terms set forth in Section 3(c). 
 (c) If a “Change of Control” (as defined in the Plan) described in Section 13(c) of the Plan occurs while the Grantee is employed by the
Company or any Subsidiary or if the Grantee dies, in either case at any time prior to December 31, 2010, then the Grantee shall be deemed to have earned 100% of the Maximum Number of Performance Shares, and the Company shall, upon such Change
of Control, deliver to Grantee (or Grantee’s estate in the case of death) the Shares underlying all earned Performance Shares, provided, however, that if such Change of Control or death occurs after December 31, 2009 and before
December 31, 2010 and Grantee is not entitled to an award of Performance Shares for the Performance Period of the year ending December 31, 2009, Grantee shall be deemed only to have earned the Performance Shares that Grantee can earn based
on the Performance Period of the year ending December 31, 2010, and the Company shall deliver to Grantee (or Grantee’s estate in the case of death) the Shares underlying such earned Performance Shares. 
 (d) Notwithstanding anything contained in this Agreement to the contrary, the Committee may, in its sole discretion, accelerate the time at which the
Performance Shares become vested and nonforfeitable on such terms and conditions as it deems appropriate. 
 4. Transferability. The
Performance Shares may not be Transferred and shall not be subject in any manner to assignment, alienation, pledge, encumbrance or charge, unless otherwise provided under the Plan. Any purported Transfer or encumbrance in violation of the provisions
of this Section 4 shall be void, and the other party to any such purported transaction shall not obtain any rights to or interest in such Performance Shares. 
 5. Dividend, Voting and Other Rights. The Grantee shall not possess any incidents of ownership (including, without limitation, dividend and voting rights) in the Shares underlying the Performance Shares until
such Shares have been delivered to the Grantee in accordance with Section 3 of this Agreement. The obligations of the Company under this Agreement will be merely that of an unfunded and unsecured promise of the Company to deliver Shares in the
future, and the rights of the Grantee will be no greater than that of an unsecured general creditor. No assets of the Company will be held or set aside as security for the obligations of the Company under this Agreement. 
 6. Continuous Employment. For purposes of this Agreement, the continuous employment of the Grantee with the Company and its Subsidiaries shall not
be deemed to have been interrupted, and the Grantee shall not be deemed to have ceased to be an employee of the Company and its Subsidiaries, by reason of the transfer of his employment among the Company and its Subsidiaries. 
  

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 7. No Employment Contract. Nothing contained in this Agreement shall confer upon the Grantee any
right with respect to continuance of employment by the Company and its Subsidiaries, nor limit or affect in any manner the right of the Company and its Subsidiaries to terminate the employment or adjust the compensation of the Grantee. 

8. Relation to Other Benefits. Any economic or other benefit to the Grantee under this Agreement or the Plan shall not be taken into account in
determining any benefits to which the Grantee may be entitled under any profit-sharing, retirement or other benefit or compensation plan maintained by the Company or a Subsidiary and shall not affect the amount of any life insurance coverage
available to any beneficiary under any life insurance plan covering employees of the Company or a Subsidiary. 
 9. Taxes and
Withholding. To the extent that the Company or any Subsidiary is required to withhold any federal, state, local, foreign or other tax in connection with the Performance Shares pursuant to this Agreement, it shall be a condition to earning the
award that the Grantee make arrangements satisfactory to the Company or such Subsidiary for payment of such taxes required to be withheld. The Committee may, in its sole discretion, require the Grantee to satisfy such required withholding obligation
by surrendering to the Company a portion of the Shares earned by the Grantee under this Agreement, and the Shares so surrendered by the Grantee shall be credited against any such withholding obligation at the Fair Market Value of such Shares on the
date of surrender. In no event shall the Fair Market Value of the Shares to be surrendered pursuant to this section to satisfy applicable withholding taxes exceed the minimum amount of taxes required to be withheld or such other amount that will not
result in a negative accounting impact. 
 10. Adjustments. The number and kind of Shares deliverable pursuant to the Performance
Shares are subject to adjustment as provided in Section 13 of the Plan. 
 11. Compliance with Law. The Company shall make
reasonable efforts to comply with all applicable federal and state securities laws and listing requirements with respect to the Performance Shares; provided, however, notwithstanding any other provision of this Agreement, the Company
shall not be obligated to deliver any Shares pursuant to this Agreement if the delivery of this Agreement would result in a violation of any such law or listing requirement. 
 12. Amendments. Subject to the terms of the Plan, the Committee may modify this Agreement upon written notice to the Grantee. Any amendment to the
Plan shall be deemed to be an amendment to this Agreement to the extent that the amendment is applicable to this Agreement. Notwithstanding the foregoing, no amendment of the Plan or this Agreement shall adversely affect the rights of the Grantee
under this Agreement without the Grantee’s consent unless the Committee determines, in good faith, that such amendment is required for the Agreement to either be exempt from the application of, or comply with, the requirements of
Section 409A of the Code, or as otherwise may provided in the Plan. 
 13. Compliance with Section 409A of the Code. It is
intended that this Agreement shall either be exempt from the application of, or comply with, the requirements of Section 409A of the Code. This Agreement shall be construed, administered, and governed in a manner that effects such intent, and
the Committee shall not take any action that would be inconsistent with such intent. Without limiting the foregoing, the Performance Shares shall not be deferred, accelerated, extended, paid out, settled, adjusted, substituted, exchanged or modified
in a manner that would cause the award to fail to satisfy the conditions of an applicable exception from the 

  

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requirements of Section 409A of the Code or otherwise would subject the Grantee to the additional tax imposed under Section 409A of the Code. The
amounts payable pursuant to this Agreement are intended to be separate payments that qualify for the “short-term deferral” exception to Section 409A of the Code to the maximum extent possible. 
 14. Severability. In the event that one or more of the provisions of this Agreement shall be invalidated for any reason by a court of competent
jurisdiction, any provision so invalidated shall be deemed to be separable from the other provisions of this Agreement, and the remaining provisions of this Agreement shall continue to be valid and fully enforceable. 
 15. Relation to Plan. This Agreement is subject to the terms and conditions of the Plan. This Agreement and the Plan contain the entire agreement
and understanding of the parties with respect to the subject matter contained in this Agreement, and supersede all prior written or oral communications, representations and negotiations with respect to this Agreement. In the event of any
inconsistency between the provisions of this Agreement and the Plan, the Plan shall govern. Capitalized terms used of this Agreement without definition shall have the meanings assigned to them in the Plan. The Committee acting pursuant to the Plan,
as constituted from time to time, shall, except as expressly provided otherwise of this Agreement, have the right to determine any questions which arise in connection with the grant of the Performance Shares. 
 16. Successors and Assigns. Without limiting Section 4, the provisions of this Agreement shall inure to the benefit of, and be binding upon,
the successors, administrators, heirs, legal representatives and assigns of the Grantee, and the successors and assigns of the Company. 
 17. Governing Law. The interpretation, performance, and enforcement of this Agreement shall be governed by the laws of the State of Delaware, without giving effect to the principles of conflict of laws of this Agreement. 

18. Electronic Delivery. The Grantee consents and agrees to electronic delivery of any documents that the Company may elect to deliver
(including, but not limited to, prospectuses, prospectus supplements, grant or award notifications and agreements, account statements, annual and quarterly reports, and all other forms of communications) in connection with this and any other award
made or offered under the Plan. The Grantee understands that, unless earlier revoked by the Grantee by giving written notice to the Chief Financial Officer of the Company, this consent shall be effective for the duration of the Agreement. The
Grantee also understands that he or she shall have the right at any time to request that the Company deliver written copies of any and all materials referred to above at no charge. The Grantee consents to any and all procedures the Company has
established or may establish for an electronic signature system for delivery and acceptance of any such documents that the Company may elect to deliver, and agrees that his or her electronic signature is the same as, and shall have the same force
and effect as, his or her manual signature. The Grantee consents and agrees that any such procedures and delivery may be effected by a third party engaged by the Company to provide administrative services related to the Plan. 
 The Company has caused this Agreement to be executed on its behalf by its duly authorized officer and the Grantee has also executed this Agreement, as of
the Grant Date. 
  

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	ATRICURE, INC.
		
	By:	 	  

	Name:	 	
	Title:	 	

 The undersigned acknowledges that a copy of the Plan, Plan Summary and Prospectus, and the
Company’s most recent Annual Report and Proxy Statement (the “Prospectus Information”) are available for viewing on the Company’s intranet site at www.atricure.com. The Grantee consents to receiving this Prospectus Information
electronically, or, in the alternative, agrees to contact the Company’s Chief Financial Officer at (513) 755-4100 to request a paper copy of the Prospectus Information at no charge. The Grantee represents that he or she is familiar with
the terms and provisions of the Prospectus Information and accepts the award of Performance Shares on the terms and conditions set forth of this Agreement and in the Plan. 
 I understand this document replaces in full the prior performance share agreement dated October 28, 2008. 
  

			
	  

	Grantee
		
	Date:	 	  

 ALTERNATIVE FOR ELECTRONIC SIGNATURE 
 You may accept the award online or by telephone in accordance with the procedures established by the Company and the Plan administrator. By accepting your
award in accordance with these procedures, you acknowledge that a copy of the Plan, Plan Summary and Prospectus, and the Company’s most recent Annual Report and Proxy Statement (the “Prospectus Information”) either have been received
by you or are available for viewing on the Company’s intranet site at www.atricure.com, and consent to receiving this Prospectus Information electronically, or, in the alternative, agree to contact the Company’s Chief Financial Officer at
(513) 755-4100 to request a paper copy of the Prospectus Information at no charge. You also represent that you are familiar with the terms and provisions of the Prospectus Information and accept the award on the terms and conditions set forth
of this Agreement and in the Plan. These terms and conditions constitute a legal contract that will bind both you and the Company as soon as you accept the award as described above. 
  

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 EXHIBIT A 
 PERFORMANCE GOALS AND PERFORMANCE PERIOD 
 Performance Period: Year Ending December 31, 2009 

 

			
	 Performance Goal:
	 	Operating income (loss) plus depreciation, amortization and share-based compensation included in operating income (loss) of the Company of at least $0.

 If, for the year ending December 31, 2009 Performance Period, the Company achieves the
Performance Goal set forth above, Grantee shall be entitled                      to Performance Shares. 
 If, for the year ending December 31, 2009 Performance Period, the Grantee fails to achieve the Performance Goal set forth above, then Grantee’s
right to earn Performance Shares for the year ending December 31, 2009 Performance Period shall be forfeited automatically without further action or notice. 
 Performance Period: Year Ending December 31, 2010 
  

			
	 Performance Goal:
	 	Increase in net revenue of the Company of at least 20% over net revenue of the Company for the year ended December 31, 2009.

 If, for the year ending December 31, 2010 Performance Period, the Company achieves the
Performance Goal set forth above, Grantee shall be entitled to                      Performance Shares. 
 If, for the year ending December 31, 2010 Performance Period, the Grantee fails to achieve the Performance Goal set forth above, then Grantee’s
right to earn Performance Shares for the year ending December 31, 2010 Performance Period shall be forfeited automatically without further action or notice.

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