Document:

Exhibit 10.9

 

NEITHER THIS SECURITY NOR THE SECURITIES INTO WHICH THIS SECURITY IS CONVERTIBLE HAVE BEEN REGISTERED WITH
THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION
UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD
EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR
IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES
LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, THE SUBSTANCE OF WHICH SHALL BE REASONABLY ACCEPTABLE
TO THE COMPANY. THIS SECURITY AND THE SECURITIES ISSUABLE UPON CONVERSION OF THIS SECURITY MAY BE PLEDGED IN CONNECTION WITH A
BONA FIDE MARGIN ACCOUNT OR OTHER LOAN SECURED BY SUCH SECURITIES.

 

Issue Date: September __, 2019 

Conversion Price (subject to adjustment
herein): $0.08 per share of Common Stock 

Maturity Date: September 30, 2029

 

 

Principal Payment: $460,000.00

 

 

15%
SENIOR SECURED 

CONVERTIBLE
PROMISSORY NOTE

DUE
September 30, 2029

 

THIS 15% SENIOR SECURED
CONVERTIBLE PROMISSORY NOTE is a duly authorized and validly issued 15% Senior Secured Convertible Promissory Notes of Mobiquity
Technologies, Inc., a New York corporation, (the “Company”), having its principal place of business at 35 Torrington
Lane, Shoreham, New York 11786, designated as its 15% Senior Secured Convertible Promissory Note due September 30, 2029 (this Note,
the “Note” and, collectively with the other Notes of such series, the “Notes”).

 

FOR VALUE RECEIVED,
the Company promises to pay to Marital Trust GST Subject U/W/O Leopold Salkind, a trust or their registered assigns (the “Holder”),
or shall have paid pursuant to the terms hereunder, the principal sum of $460,000.00 on September 30, 2029 (the “Maturity
Date”) or such earlier date as this Note is required or permitted to be repaid as provided hereunder, and to pay interest
to the Holder on the aggregate unconverted and then outstanding principal amount of this Note in accordance with the provisions
hereof. This Note is subject to the following additional provisions:

 

Section 1.       Definitions.
For the purposes hereof, the following terms shall have the following meanings:

 

“Alternate
Consideration” shall have the meaning set forth in Section 5(d).

 

“Bankruptcy
Event” means any of the following events: (a) the Company or any Significant Subsidiary (as such term is defined in Rule
1-02(w) of Regulation S-X) thereof commences a case or other proceeding under any bankruptcy, reorganization, arrangement, adjustment
of debt, relief of debtors, dissolution, insolvency or liquidation or similar law of any jurisdiction relating to the Company or
any Significant Subsidiary thereof, (b) there is commenced against the Company or any Significant Subsidiary thereof any such case
or proceeding that is not dismissed within 90 days after commencement, (c) the Company or any Significant Subsidiary thereof is
adjudicated insolvent or bankrupt or any order of relief or other order approving any such case or proceeding is entered, (d) the
Company or any Significant Subsidiary thereof suffers any appointment of any custodian or the like for it or any substantial part
of its property that is not discharged or stayed within 90 calendar days after such appointment, (e) the Company or any Significant
Subsidiary thereof makes a general assignment for the benefit of creditors, (f) the Company or any Significant Subsidiary thereof
calls a meeting of its creditors with a view to arranging a composition, adjustment or restructuring of its debts or (g) the Company
or any Significant Subsidiary thereof, by any act or failure to act, expressly indicates its consent to, approval of or acquiescence
in any of the foregoing or takes any corporate or other action for the purpose of effecting any of the foregoing.

 

 

 

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“Business
Day” means any day except any Saturday, any Sunday, any day which is a federal legal holiday in the United States or
any day on which banking institutions in the State of New York are authorized or required by law or other governmental action to
close.

 

“Buy-In”
shall have the meaning set forth in Section 4(v)(v).

 

“Change
of Control Transaction” means the occurrence after the date hereof of any of (a) an acquisition after the date hereof
by an individual or legal entity or “group” (as described in Rule 13d-5(b)(1) promulgated under the Exchange Act) of
effective control (whether through legal or beneficial ownership of capital stock of the Company, by contract or otherwise) of
in excess of 50% of the voting securities of the Company (other than by means of conversion or exercise of the Notes and the Warrants
issued together with the Notes), (b) the Company merges into or consolidates with any other Person, or any Person merges into or
consolidates with the Company and, after giving effect to such transaction, the stockholders of the Company immediately prior to
such transaction own less than 50% of the aggregate voting power of the Company or the successor entity of such transaction, (c)
the Company sells or transfers all or substantially all of its assets to another Person and the stockholders of the Company immediately
prior to such transaction own less than 50% of the aggregate voting power of the acquiring entity immediately after the transaction,
(d) a replacement at one time or within a three year period of more than one-half of the members of the Board of Directors which
is not approved by a majority of those individuals who are members of the Board of Directors on the Original Issue Date (or by
those individuals who are serving as members of the Board of Directors on any date whose nomination to the Board of Directors was
approved by a majority of the members of the Board of Directors who are members on the date hereof), or (e) the execution by the
Company of an agreement to which the Company is a party or by which it is bound, providing for any of the events set forth in clauses
(a) through (d) above.

 

“Common
Stock” means the common stock of the Company, $0.0001 par value per share.

 

“Conversion”
shall have the meaning ascribed to such term in Section 4.

 

“Conversion
Date” shall have the meaning set forth in Section 4(a).

 

“Conversion
Price” shall have the meaning set forth in Section 4(b).

 

“Conversion
Shares” means, collectively, the shares of Common Stock issuable upon conversion of this Note in accordance with the
terms hereof.

 

“DTC”
means the Depository Trust Company.

 

“DTC/FAST
Program” means the DTC’s Fast Automated Securities Transfer Program.

 

“DWAC”
means Deposit Withdrawal at Custodian as defined by the DTC.

 

“DWAC
Eligible” means that (a) the Common Stock is eligible at DTC for full services pursuant to DTC’s Operational Arrangements,
including without limitation transfer through DTC’s DWAC system, (b) the Company has been approved (without revocation) by
the DTC’s underwriting department, (c) the Transfer Agent is approved as an agent in the DTC/FAST Program, (d) the Conversion
Shares are otherwise eligible for delivery via DWAC, and (e) the Transfer Agent does not have a policy prohibiting or limiting
delivery of the Conversion Shares via DWAC.

 

“Equity
Conditions” means, during the period in question, (a) the Company shall have duly honored all conversions and redemptions
scheduled to occur or occurring by virtue of one or more Notices of Conversion of the Holder, if any, (b) the Company shall have
paid all liquidated damages and other amounts owing to the Holder in respect of this Note, (c) all of the Conversion Shares issuable
pursuant to the Transaction Documents (and shares issuable in lieu of cash payments of interest) may be resold pursuant to Rule
144 without volume or manner-of-sale restrictions or current public information requirements as determined by the counsel to the
Company as set forth in a written opinion letter to such effect, addressed and acceptable to the Transfer Agent and the Holder,
(d) the Common Stock is trading on a Trading Market and all of the shares issuable pursuant to the Transaction Documents are listed
or quoted for trading on such Trading Market (and the Company believes, in good faith, that trading of the Common Stock on a Trading
Market will continue uninterrupted for the foreseeable future), (e) there is a sufficient number of authorized but unissued and
otherwise unreserved shares of Common Stock for the issuance of all of the shares then issuable pursuant to the Transaction Documents,
(f) there is no existing Event of Default and no existing event which, with the passage of time or the giving of notice, would
constitute an Event of Default, (g) there has been no public announcement of a pending or proposed Fundamental Transaction or Change
of Control Transaction that has not been consummated, (h) the applicable Holder is not in possession of any information provided
by the Company that constitutes, or may constitute, material non-public information, and (i) the Company’s Common Stock must
be DTC and DWAC Eligible.

 

 

 

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“Event
of Default” shall have the meaning set forth in Section 6(a).

 

“Fundamental
Transaction” shall have the meaning set forth in Section 5(d).

 

“New
York Courts” shall have the meaning set forth in Section 7(d).

 

“Note
Register” shall have the meaning set forth in Section 2(c).

 

“Notice
of Conversion” shall have the meaning set forth in Section 4(a).

 

“Original
Issue Date” means the date of the first issuance of the Notes, regardless of any transfers of any Note and regardless
of the number of instruments which may be issued to evidence such Notes.

 

“Person”
means an individual or corporation, partnership, trust, incorporated or unincorporated association, joint venture, limited liability
company, joint stock company, government (or an agency or subdivision thereof) or other entity of any kind.

 

“Principal
Payment” shall have the meaning set forth in Section 2(d).

 

“Required
Minimum” means, as of any date, the maximum aggregate number of shares of Common Stock then issued or potentially issuable
in the future pursuant to the Transaction Documents, including any shares of Common Stock issuable upon conversion in full of all
Notes (including shares of Common Stock issuable as payment of interest on the Notes).

 

“Securities”
means the Notes, the Warrants, and the Common Stock underlying the Notes and Warrants.

 

“Securities
Act” means the Securities Act of 1933, as amended, and the rules and regulations promulgated thereunder.

 

“Share
Delivery Date” shall have the meaning set forth in Section 4(d)(ii).

 

“Subscription
Agreement” means the Subscription Agreement between the Company and the original Holder of this Note, pursuant to which
such Holder subscribed for the purchase of this Note. “Subscription Agreements” means the Subscription Agreements
of all the original Holders of all the Notes.

 

“Successor
Entity” shall have the meaning set forth in Section 5(e).

 

“Trading
Day” means a day on which the principal Trading Market is open for trading.

 

“Trading
Market” means any of the following markets or exchanges on which the Common Stock is listed or quoted for trading on
the date in question: the NYSE MKT, the Nasdaq Capital Market, the Nasdaq Global Market, the Nasdaq Global Select Market, the New
York Stock Exchange, OTCQB, or OTCQX (or any successors to any of the foregoing).

 

“Transaction
Documents” means the all the Subscription Agreements, the Notes, the Security Agreement, the Warrants, all exhibits and
schedules thereto and hereto and any other documents or agreements executed in connection with the transactions contemplated hereunder.

 

“VWAP”
means, for any date, the price determined by the first of the following clauses that applies: (a) if the Common Stock is then listed
or quoted on a Trading Market, the daily volume weighted average price of the Common Stock for such date (or the nearest preceding
date) on the Trading Market on which the Common Stock is then listed or quoted as reported by Bloomberg L.P. (based on a Trading
Day from 9:30 a.m. (New York City time) to 4:02 p.m. (New York City time)), (b)  if the OTCQB, OTCQX is not a Trading Market,
the volume weighted average price of the Common Stock for such date (or the nearest preceding date) on the OTC Bulletin Board,
or (c) if the Common Stock is not then listed or quoted for trading on the OTC Bulletin Board and if prices for the Common Stock
are then reported in the “Pink Sheets” published by Pink OTC Markets Group, Inc. (or a similar organization or agency
succeeding to its functions of reporting prices), the most recent bid price per share of the Common Stock so reported.

 

 

 

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“Warrants”
means Common Stock Purchase Warrants to purchase a number of shares of the Company’s Common Stock equal to 50% of the number
of Conversion Shares issuable in full conversion of the original Principal Payment of this Note, during an exercise period of ten
(10) years from the Original Issuance Date, at an exercise price of Twelve Cents ($0.12) per share, subject to adjustment as set
forth in the Warrant.

 

Section 2.       Principal Payment
and Interest.

 

a)              
Payment of Interest in Cash or Kind. The Company shall pay interest to the Holder on the aggregate unconverted and then
outstanding principal amount of this Note at the rate of fifteen percent (15%) per annum, payable monthly in arrears by the 15th
day of month commencing in October 2019, in cash or, at the Holder’s option, in duly authorized, validly issued, fully paid
and non-assessable shares of Common Stock on the same terms as the issuance of shares of Common Stock upon such Conversion, or
a combination thereof.

 

b)              
Interest Calculations. Interest shall be calculated on the basis of a 360-day year, consisting of twelve (12) thirty (30)
calendar day periods, and shall accrue daily commencing on the Original Issue Date until payment in full of the outstanding principal,
together with all accrued and unpaid interest, liquidated damages and other amounts which may become due hereunder, has been made.
Payment of interest in shares of Common Stock shall otherwise occur pursuant to Section 4(c)(ii) herein. Interest hereunder will
be paid to the Person in whose name this Note is registered on the records of the Company regarding registration and transfers
of this Note (the “Note Register”). Except as otherwise provided herein, if at any time the Company pays interest
partially in cash and partially in shares of Common Stock to the holders of the Notes, then such payment of cash shall be distributed
ratably among the holders of the then-outstanding Notes based on their (or their predecessor’s) initial purchases of Notes.

 

c)              
Maturity Date Payment. On the Maturity Date, the Company shall redeem one hundred percent (100%) of the face amount of this
Note (the “Principal Payment”) together with all accrued and unpaid interest thereon. The Principal Payment
together with all accrued and unpaid interest thereon shall, at the option of the Holder, be made in cash or, subject to fulfillment
of the Equity Conditions on the Maturity Date, be made in Common Stock at the Conversion Price.

 

d)              
Prepayment. Within the first thirty six (36) months following the Original Issue Date upon the mutual written consent of
the Holder and the Company, and thereafter at any time upon ten (10) days written notice to the Holder, the Company may prepay
any portion of the principal amount of this Note and any accrued and unpaid interest. If the Company exercises its right to prepay
the Note, the Company shall make payment to the Holder of an amount in cash equal to the sum of the then outstanding principal
amount of this Note and guaranteed interest. The Holder may continue to convert the Note from the date notice of the prepayment
is given until the date of the prepayment. Notwithstanding anything contained herein to the contrary, a Prepayment of this Note
within three (3) Trading Days prior to the Maturity Date of the Note shall not be deemed a Prepayment.

 

Section 3.       Registration
of Transfers and Exchanges.

 

a)              
Different Denominations. This Note is exchangeable for an equal aggregate principal amount of Notes of different authorized
denominations, as requested by the Holder surrendering the same. No service charge will be payable for such registration of transfer
or exchange.

 

b)              
Investment Representations. This Note has been issued subject to certain investment representations of the original Holder
set forth in the Subscription Agreement and may be transferred or exchanged only in compliance with applicable federal and state
securities laws and regulations.

 

c)              
Reliance on Note Register. Prior to due presentment for transfer to the Company of this Note, the Company and any agent
of the Company may treat the Person in whose name this Note is duly registered on the Note Register as the owner hereof for the
purpose of receiving payment as herein provided and for all other purposes, whether or not this Note is overdue, and neither the
Company nor any such agent shall be affected by notice to the contrary.

 

 

 

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Section 4.       Conversion.

 

a)              
Voluntary Conversion by Holder. Subject to Section 4(b) and Section 4(f), at any time after the Original Issue Date until
this Note is no longer outstanding, this Note shall be convertible, in whole or in part, into Conversion Shares at the option of
the Holder, at any time and from time to time. The Holder shall effect conversions by delivering to the Company a Notice of Conversion,
the form of which is attached hereto as Annex A (each, a “Notice of Conversion”), specifying therein
the principal amount of this Note to be converted and the date on which such conversion shall be effected, which date may include
the Maturity Date (such date, the “Conversion Date”). If no Conversion Date is specified in a Notice of Conversion,
the Conversion Date shall be the date that such Notice of Conversion is deemed delivered hereunder. No ink-original Notice of Conversion
shall be required, nor shall any medallion guarantee (or other type of guarantee or notarization) of any Notice of Conversion form
be required. The Company may deliver an objection to any Notice of Conversion within one (1) Business Day of delivery of such Notice
of Conversion. In the event of any dispute or discrepancy, the records of the Holder shall be controlling and determinative in
the absence of manifest error. The Holder, and any assignee by acceptance of this Note, acknowledge and agree that, by reason
of the provisions of this paragraph, following conversion of a portion of this Note, the unpaid and unconverted principal amount
of this Note may be less than the amount stated on the face hereof.

 

b)              
Right to Effect Conversion by the Company. Subject to Section 4(f), at any time after the Original Issue Date that the trailing
thirty (30) day VWAP of the Company’s Common Stock is above One Dollar ($1.00) per share, subject to adjustment as set forth
in Section 5 as applicable, until this Note is no longer outstanding, the Company may convert the entire unpaid un-converted principal
amount of this Note, plus all accrued and unpaid interest thereon, into Conversion Shares. The Company shall effect the conversion
under this Section 4(b) by delivering to the Holder a notice of such conversion (the “Company Conversion Notice”),
with no further action of the Holder on the date the Company Conversion Notice is deemed delivered in accordance with Section 8(a).
In the event of a Company effected conversion pursuant to this Section 4(b), the “Conversion Date” shall be the date
of delivery of the Company Conversion Notice.

 

c)              
Effect of Conversions on Note. To effect conversions hereunder, the Holder shall not be required to physically surrender
this Note to the Company unless the entire principal amount of this Note, plus all accrued and unpaid interest thereon, has been
so converted. Conversions hereunder shall have the effect of lowering the outstanding principal amount of this Note in an amount
equal to the applicable conversion. The Holder and the Company shall maintain records showing the principal amount(s) converted
and the date of such conversion(s).

 

d)              
Conversion Price. The fixed conversion price in effect on any Conversion Date shall be equal to Eight Cents ($0.08), subject
to adjustment herein (the “Conversion Price”).

 

e)              
Mechanics of Conversion.

 

i.                   
Conversion Shares Issuable Upon Conversion of Principal Amount. The number of Conversion Shares issuable upon a conversion
hereunder shall be determined by the quotient obtained by dividing (x) the outstanding principal amount of this Note to be converted
by (y) the Conversion Price.

 

ii.                   
Delivery of Certificate Upon Conversion. Not later than five (5) Trading Days after each Conversion Date (the “Share
Delivery Date”), the Company shall deliver, or cause to be delivered, to the Holder (A) a certificate or certificates
representing the Conversion Shares, and (B) a bank check in the amount of accrued and unpaid interest (if the Company has elected
or is required to pay accrued interest in cash). All certificate or certificates required to be delivered by the Company under
this Section 4(e) shall be delivered electronically through the Depository Trust Company or another established clearing corporation
performing similar functions. The Conversion Shares shall bear a restrictive legend in the following form, as appropriate:

 

“NEITHER THE ISSUANCE
AND SALE OF THE SECURITIES REPRESENTED BY THIS CERTIFICATE NOR THE SECURITIES INTO WHICH THESE SECURITIES ARE EXERCISABLE HAVE
BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR APPLICABLE STATE SECURITIES LAWS.  THE SECURITIES MAY
NOT BE OFFERED FOR SALE, SOLD, TRANSFERRED OR ASSIGNED (I) IN THE ABSENCE OF (A) AN EFFECTIVE REGISTRATION STATEMENT FOR THE SECURITIES
UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR (B) AN OPINION OF COUNSEL (WHICH COUNSEL SHALL BE SELECTED BY THE HOLDER), IN
A GENERALLY ACCEPTABLE FORM, THAT REGISTRATION IS NOT REQUIRED UNDER SAID ACT OR (II) UNLESS SOLD PURSUANT TO RULE 144 OR RULE
144A UNDER SAID ACT. NOTWITHSTANDING THE FOREGOING, THE SECURITIES MAY BE PLEDGED IN CONNECTION WITH A BONA FIDE MARGIN
ACCOUNT OR OTHER LOAN OR FINANCING ARRANGEMENT SECURED BY THE SECURITIES.”

 

 

 

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iii.                   
Failure to Deliver Certificates. If, in the case of any Notice of Conversion, such certificate or certificates are not delivered
to or as directed by the applicable Holder by the Share Delivery Date, the Holder shall be entitled to elect by written notice
to the Company at any time on or before its receipt of such certificate or certificates, to rescind such Conversion, in which event
the Company shall promptly return to the Holder any original Note delivered to the Company and the Holder shall promptly return
to the Company the Common Stock certificates issued to such Holder pursuant to the rescinded Conversion Notice.

 

iv.                   
Obligation Absolute; Partial Liquidated Damages. The Company’s obligations to issue and deliver the Conversion Shares
upon conversion of this Note in accordance with the terms hereof are absolute and unconditional, irrespective of any action or
inaction by the Holder to enforce the same, any waiver or consent with respect to any provision hereof, the recovery of any judgment
against any Person or any action to enforce the same, or any setoff, counterclaim, recoupment, limitation or termination, or any
breach or alleged breach by the Holder or any other Person of any obligation to the Company or any violation or alleged violation
of law by the Holder or any other Person, and irrespective of any other circumstance which might otherwise limit such obligation
of the Company to the Holder in connection with the issuance of such Conversion Shares; provided, however, that such
delivery shall not operate as a waiver by the Company of any such action the Company may have against the Holder. In the event
the Holder of this Note shall elect to convert any or all of the outstanding principal amount hereof, the Company may not refuse
conversion based on any claim that the Holder or anyone associated or affiliated with the Holder has been engaged in any violation
of law, agreement or for any other reason, unless an injunction from a court, on notice to Holder, restraining and or enjoining
conversion of all or part of this Note shall have been sought and obtained and the Company posts a surety bond for the benefit
of the Holder in the amount of 120% of the outstanding principal amount of this Note, which is subject to the injunction, which
bond shall remain in effect until the completion of arbitration/litigation of the underlying dispute and the proceeds of which
shall be payable to the Holder to the extent it obtains judgment. In the absence of such injunction, the Company shall issue Conversion
Shares or, if applicable, cash, upon a properly noticed conversion. If the Company fails for any reason to deliver to the Holder
such certificate or certificates pursuant to Section 4(e)(ii) by the Share Delivery Date, the Company shall pay to the Holder,
in cash, as liquidated damages and not as a penalty, for each $1,000 of principal amount being converted, $1.00 per Trading Day
(increasing to $2.00 per Trading Day on the twentieth (20th) Trading Day after such liquidated damages begin to accrue)
for each Trading Day after such Share Delivery Date until such certificates are delivered or Holder rescinds such conversion. Nothing
herein shall limit a Holder’s right to pursue actual damages or declare an Event of Default pursuant to Section 6 hereof
for the Company’s failure to deliver Conversion Shares within the period specified herein and the Holder shall have the right
to pursue all remedies available to it hereunder, at law or in equity including, without limitation, a decree of specific performance
and/or injunctive relief. The exercise of any such rights shall not prohibit the Holder from seeking to enforce damages pursuant
to any other Section hereof or under applicable law.

 

v.                   
Compensation for Buy-In on Failure to Timely Deliver Certificates Upon Conversion. In addition to any other rights available
to the Holder, if the Company fails for any reason to deliver to the Holder such certificate or certificates by the Share Delivery
Date pursuant to Section 4(e)(ii), and if after such Share Delivery Date the Holder is required by its brokerage firm to purchase
(in an open market transaction or otherwise), or the Holder’s brokerage firm otherwise purchases, shares of Common Stock
to deliver in satisfaction of a sale by the Holder of the Conversion Shares in compliance with applicable securities laws which
the Holder was entitled to receive upon the conversion relating to such Share Delivery Date (a “Buy-In”), then
the Company shall (A) pay in cash to the Holder (in addition to any other remedies available to or elected by the Holder) the amount,
if any, by which (x) the Holder’s total purchase price (including any brokerage commissions) for the Common Stock so purchased
exceeds (y) the product of (1) the aggregate number of shares of Common Stock that the Holder was entitled to receive from the
conversion at issue multiplied by (2) the actual sale price at which the sell order giving rise to such purchase obligation was
executed (including any brokerage commissions) and (B) at the option of the Holder, either reissue (if surrendered) this Note in
a principal amount equal to the principal amount of the attempted Conversion (in which case such Conversion shall be deemed rescinded)
or deliver to the Holder the number of shares of Common Stock that would have been issued if the Company had timely complied with
its delivery requirements under Section 4(e)(ii). For example, if the Holder purchases Common Stock having a total purchase price
of $11,000 to cover a Buy-In with respect to an attempted conversion of this Note with respect to which the actual sale price of
the Conversion Shares (including any brokerage commissions) giving rise to such purchase obligation was a total of $10,000 under
clause (A) of the immediately preceding sentence, the Company shall be required to pay the Holder $1,000. The Holder shall provide
the Company written notice indicating the amounts payable to the Holder in respect of the Buy-In and, upon request of the Company,
evidence of the amount of such loss. Nothing herein shall limit a Holder’s right to pursue any other remedies available to
it hereunder, at law or in equity including, without limitation, a decree of specific performance and/or injunctive relief with
respect to the Company’s failure to timely deliver certificates representing shares of Common Stock upon conversion of this
Note as required pursuant to the terms hereof.

 

 

 

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vi.                   
Authorized Shares and Listing. If, on any date, the number of authorized but unissued
(and otherwise unreserved) shares of Common Stock is less than 100% of the Required Minimum on such date, then the Board of Directors
shall use commercially reasonable efforts to amend the Company’s certificate or articles of incorporation to increase the
number of authorized but unissued shares of Common Stock to at least 100% of the Required Minimum at such time, as soon as possible
and in any event not later than the 120th day after such date. The Company shall, if applicable: (A) in the time and
manner required by the principal Trading Market, prepare and file with such Trading Market an additional shares listing application
covering a number of shares of Common Stock at least equal to the Required Minimum on the date of such application; (B) take all
steps necessary to cause such shares of Common Stock to be approved for listing or quotation on such Trading Market as soon as
possible thereafter; (C) provide to the Purchasers evidence of such listing or quotation; and (D) maintain the listing or quotation
of such Common Stock on any date at least equal to the Required Minimum on such date on such Trading Market or another Trading
Market.

 

vii.                   
Fractional Shares. No fractional shares or scrip representing fractional shares shall be issued upon the conversion of this
Note. As to any fraction of a share which the Holder would otherwise be entitled to purchase upon such conversion, the Company
shall at its election, either pay a cash adjustment in respect of such final fraction in an amount equal to such fraction multiplied
by the Conversion Price or round up to the next whole share.

 

viii.                   
Transfer Taxes and Expenses. The issuance of certificates for shares of the Common Stock on conversion of this Note shall
be made without charge to the Holder hereof for any documentary stamp or similar taxes that may be payable in respect of the issue
or delivery of such certificates, provided that, the Company shall not be required to pay any tax that may be payable in respect
of any transfer involved in the issuance and delivery of any such certificate upon conversion in a name other than that of the
Holder of this Note so converted and the Company shall not be required to issue or deliver such certificates unless or until the
Person or Persons requesting the issuance thereof shall have paid to the Company the amount of such tax or shall have established
to the satisfaction of the Company that such tax has been paid. The Company shall pay all Transfer Agent fees required for same-day
processing of any Notice of Conversion.

 

f)               
Condition to Conversion. Notwithstanding anything to the contrary in this Note, the conversion of all or any portion of
this Note is subject to and conditioned upon the Company obtaining prior approval of the Company’s shareholders for the issuance
of the shares of Common Stock upon conversion of this Note, if and to the extent required by New York Business Corporation Law
Section 912 (Requirements relating to certain business combinations) (the “BCL 912 Shareholder Approval”), and this
Note shall not be convertible in whole or in part unless and until such BCL Shareholder Approval is obtained.

 

Section 5.       Certain
Adjustments.

 

a)              
Stock Dividends and Stock Splits. If the Company, at any time while this Note is outstanding: (i) pays a stock dividend
or otherwise makes a distribution or distributions payable in shares of Common Stock on shares of Common Stock or any Common Stock
Equivalents (which, for avoidance of doubt, shall not include any shares of Common Stock issued by the Company upon conversion
of, or payment of interest on, the Notes), (ii) subdivides outstanding shares of Common Stock into a larger number of shares, (iii)
combines (including by way of a reverse stock split) outstanding shares of Common Stock into a smaller number of shares or (iv)
issues, in the event of a reclassification of shares of the Common Stock, any shares of capital stock of the Company, then the
Conversion Price shall be multiplied by a fraction of which the numerator shall be the number of shares of Common Stock (excluding
any treasury shares of the Company) outstanding immediately before such event, and of which the denominator shall be the number
of shares of Common Stock outstanding immediately after such event. Any adjustment made pursuant to this Section shall become effective
immediately after the record date for the determination of stockholders entitled to receive such dividend or distribution and shall
become effective immediately after the effective date in the case of a subdivision, combination or re-classification.

 

 

 

    	 	7	 

     

    

 

b)              
Pro Rata Distributions. During such time as this Note is outstanding, if the Company shall declare or make any dividend
or other distribution of its assets (or rights to acquire its assets) to holders of shares of Common Stock, by way of return of
capital or otherwise (including, without limitation, any distribution of cash, stock or other securities, property or options by
way of a dividend, spin off, reclassification, corporate rearrangement, scheme of arrangement or other similar transaction) (a
"Distribution"), at any time after the issuance of this Note, then, in each such case, the Holder shall be entitled
to participate in such Distribution to the same extent that the Holder would have participated therein if the Holder had held the
number of shares of Common Stock acquirable upon complete exercise of this Note immediately before the date of which a record is
taken for such Distribution, or, if no such record is taken, the date as of which the record holders of shares of Common Stock
are to be determined for the participation in such Distribution.

 

c)              
Fundamental Transaction. If, at any time while this Note is outstanding, (i) the Company, directly or indirectly, in one
or more related transactions effects any merger or consolidation of the Company with or into another Person, (ii) the Company,
directly or indirectly, effects any sale, lease, license, assignment, transfer, conveyance or other disposition of all or substantially
all of its assets in one or a series of related transactions, (iii) any, direct or indirect, purchase offer, tender offer or exchange
offer (whether by the Company or another Person) is completed pursuant to which holders of Common Stock are permitted to sell,
tender or exchange their shares for other securities, cash or property and has been accepted by the holders of more than 50% of
the outstanding Common Stock, (iv) the Company, directly or indirectly, in one or more related transactions effects any reclassification,
reorganization or recapitalization of the Common Stock or any compulsory share exchange pursuant to which the Common Stock is effectively
converted into or exchanged for other securities, cash or property, (v) the Company, directly or indirectly, in one or more related
transactions consummates a stock or share purchase agreement or other business combination (including, without limitation, a reorganization,
recapitalization, spin-off or scheme of arrangement) with another Person whereby such other Person acquires 50% or more of the
outstanding shares of Common Stock (not including any shares of Common Stock held by the other Person or other Persons making or
party to, or associated or affiliated with the other Persons making or party to, such stock or share purchase agreement or other
business combination) (each a “Fundamental Transaction”), then, upon any subsequent conversion of this Note,
the Holder shall have the right to receive, for each Conversion Share that would have been issuable upon such conversion immediately
prior to the occurrence of such Fundamental Transaction, the number of shares of Common Stock of the successor or acquiring corporation
or of the Company, if it is the surviving corporation, and any additional consideration (the “Alternate Consideration”)
receivable as a result of such Fundamental Transaction by a holder of the number of shares of Common Stock for which this Note
is convertible immediately prior to such Fundamental Transaction. For purposes of any such conversion, the determination of the
Conversion Price shall be appropriately adjusted to apply to such Alternate Consideration based on the amount of Alternate Consideration
issuable in respect of one (1) share of Common Stock in such Fundamental Transaction, and the Company shall apportion the Conversion
Price among the Alternate Consideration in a reasonable manner reflecting the relative value of any different components of the
Alternate Consideration. If holders of Common Stock are given any choice as to the securities, cash or property to be received
in a Fundamental Transaction, then the Holder shall be given the same choice as to the Alternate Consideration it receives upon
any conversion of this Note following such Fundamental Transaction. The Company shall cause any successor entity in a Fundamental
Transaction in which the Company is not the survivor (the “Successor Entity”) to assume in writing all of the
obligations of the Company under this Note in accordance with the provisions of this Section 5(d) pursuant to written agreements
in form and substance reasonably satisfactory to the Holder and approved by the Holder (without unreasonable delay) prior to such
Fundamental Transaction and shall, at the option of the holder of this Note, deliver to the Holder in exchange for this Note a
security of the Successor Entity evidenced by a written instrument substantially similar in form and substance to this Note which
is convertible for a corresponding number of shares of capital stock of such Successor Entity (or its parent entity) equivalent
to the shares of Common Stock acquirable and receivable upon conversion of this Note prior to such Fundamental Transaction, and
with a conversion price which applies the Conversion Price hereunder to such shares of capital stock (but taking into account the
relative value of the shares of Common Stock pursuant to such Fundamental Transaction and the value of such shares of capital stock,
such number of shares of capital stock and such Conversion Price being for the purpose of protecting the economic value of this
Note immediately prior to the consummation of such Fundamental Transaction), and which is reasonably satisfactory in form and substance
to the Holder. Upon the occurrence of any such Fundamental Transaction, the Successor Entity shall succeed to, and be substituted
for (so that from and after the date of such Fundamental Transaction, the provisions of this Note and the other Transaction Documents
referring to the “Company” shall refer instead to the Successor Entity), and may exercise every right and power of
the Company and shall assume all of the obligations of the Company under this Note and the other Transaction Documents with the
same effect as if such Successor Entity had been named as the Company herein.

 

 

 

    	 	8	 

     

    

 

d)              
Calculations. All calculations under this Section 5 shall be made to the nearest cent or the nearest 1/100th of a share,
as the case may be. For purposes of this Section 5, the number of shares of Common Stock deemed to be issued and outstanding as
of a given date shall be the sum of the number of shares of Common Stock (excluding any treasury shares of the Company) issued
and outstanding.

 

e)              
Notice to the Holder.

 

i.                   
Adjustment to Conversion Price. Whenever the Conversion Price is adjusted pursuant to any provision of this Section 5, the
Company shall promptly deliver to each Holder a notice setting forth the Conversion Price after such adjustment and setting forth
a brief statement of the facts requiring such adjustment.

 

ii.                   
Notice to Allow Conversion by Holder. If (A) the Company shall declare a dividend (or any other distribution in whatever
form) on the Common Stock, (B) the Company shall declare a special nonrecurring cash dividend on or a redemption of the Common
Stock, (C) the Company shall authorize the granting to all holders of the Common Stock of rights or warrants to subscribe for or
purchase any shares of capital stock of any class or of any rights, (D) the approval of any stockholders of the Company shall be
required in connection with any reclassification of the Common Stock, any consolidation or merger to which the Company is a party,
any sale or transfer of all or substantially all of the assets of the Company, or any compulsory share exchange whereby the Common
Stock is converted into other securities, cash or property or (E) the Company shall authorize the voluntary or involuntary dissolution,
liquidation or winding up of the affairs of the Company, then, in each case, the Company shall cause to be filed at each office
or agency maintained for the purpose of conversion of this Note, and shall cause to be delivered to the Holder at its last address
as it shall appear upon the Note Register, at least twenty (20) calendar days prior to the applicable record or effective date
hereinafter specified, a notice stating (x) the date on which a record is to be taken for the purpose of such dividend, distribution,
redemption, rights or warrants, or if a record is not to be taken, the date as of which the holders of the Common Stock of record
to be entitled to such dividend, distributions, redemption, rights or warrants are to be determined or (y) the date on which such
reclassification, consolidation, merger, sale, transfer or share exchange is expected to become effective or close, and the date
as of which it is expected that holders of the Common Stock of record shall be entitled to exchange their shares of the Common
Stock for securities, cash or other property deliverable upon such reclassification, consolidation, merger, sale, transfer or share
exchange, provided that the failure to deliver such notice or any defect therein or in the delivery thereof shall not affect the
validity of the corporate action required to be specified in such notice. To the extent that any notice provided hereunder constitutes,
or contains, material, non-public information regarding the Company or any of the Subsidiaries, the Company shall simultaneously
file such notice with the Commission pursuant to a Current Report on Form 8-K. The Holder shall remain entitled to convert this
Note during the 20-day period commencing on the date of such notice through the effective date of the event triggering such notice
except as may otherwise be expressly set forth herein.

 

Section 6.       Events
of Default.

 

a)              
“Event of Default” means, wherever used herein, any of the following events (whatever the reason for such event
and whether such event shall be voluntary or involuntary or effected by operation of law or pursuant to any judgment, decree or
order of any court, or any order, rule or regulation of any administrative or governmental body):

 

i.                   
any default in the payment of (A) the principal amount of any Note or (B) interest, liquidated damages and other amounts
owing to a Holder on any Note, as and when the same shall become due and payable (whether on a Conversion Date or the Maturity
Date or by acceleration or otherwise) which default, solely in the case of an interest payment or other default under clause (B)
above, is not cured within fifteen (15) Trading Days;

 

ii.                   
the Company shall fail to observe or perform any other covenant or agreement contained in the Notes (other than a breach
by the Company of its obligations to deliver shares of Common Stock to the Holder upon conversion, which breach is addressed in
clause (xi) below) which failure is not cured, if possible to cure, within the earlier to occur of (A) ten (10) Trading Days after
notice of such failure sent by the Holder or by any other Holder to the Company and (B) twenty (20) Trading Days after the Company
has become or should have become aware of such failure;

 

 

 

    	 	9	 

     

    

 

iii.                   
a default or event of default (subject to any grace or cure period provided in the applicable agreement, document or instrument)
shall occur under (A) any of the Transaction Documents or (B) any other material agreement, lease, document or instrument
to which the Company or any Subsidiary is obligated except for a default set forth in Schedule 6(a)(iii) to this Note;

 

iv.                   
any representation or warranty made in this Note, any other Transaction Documents, any written statement pursuant hereto
or thereto or any other report, financial statement or certificate made or delivered to the Holder or any other Holder shall be
untrue or incorrect in any material respect as of the date when made or deemed made;

 

v.                   
the Company or any Significant Subsidiary (as such term is defined in Rule 1-02(w) of Regulation S-X) shall be subject to
a Bankruptcy Event;

 

vi.                   
the Common Stock shall not be (A) eligible for listing or quotation for trading on a Trading Market and shall not be eligible
to resume listing or quotation for trading thereon within five (5) Trading Days or (B) listed or quoted for trading on the OTC
Markets (or a similar organization or agency succeeding to its functions of reporting prices); or prices for the Common Stock are
not reported in the “Pink Sheets” published by Pink OTC Markets Group, Inc. (or a similar organization or agency succeeding
to its functions of reporting prices); or the transfer of shares of Common Stock through the Depository Trust Company System is
no longer available or “chilled”;

 

vii.                   
the Company shall fail for any reason to deliver certificates via DWAC to a Holder prior to the fifteenth (15th)
Trading Day after a Conversion Date pursuant to Section 4(e) or the Company shall provide at any time notice to the Holder, including
by way of public announcement, of the Company’s intention to not honor requests for conversions of any Notes in accordance
with the terms hereof;

 

viii.                   
the Company fails to file with the Commission any required reports under Section 13 or 15(d) of the Exchange Act such that
it is not in compliance with Rule 144(c)(1) (or Rule 144(i)(2), if applicable); however, no default shall occur unless the failure
to file is for a period of at least fifteen (15) calendar days past the SEC required filing date;

 

ix.                   
if the Company or any Significant Subsidiary shall: (i) apply for or consent to the appointment of a receiver, trustee,
custodian or liquidator of it or any of its properties, (ii) admit in writing its inability to pay its debts as they mature, (iii)
make a general assignment for the benefit of creditors, (iv) be adjudicated a bankrupt or insolvent or be the subject of an order
for relief under Title 11 of the United States Code or any bankruptcy, reorganization, insolvency, readjustment of debt, dissolution
or liquidation law or statute of any other jurisdiction or foreign country, or (v) file a voluntary petition in bankruptcy, or
a petition or an answer seeking reorganization or an arrangement with creditors or to take advantage or any bankruptcy, reorganization,
insolvency, readjustment of debt, dissolution or liquidation law or statute, or an answer admitting the material allegations of
a petition filed against it in any proceeding under any such law, or (vi) take or permit to be taken any action in furtherance
of or for the purpose of effecting any of the foregoing;

 

x.                   
if any order, judgment or decree shall be entered, without the application, approval or consent of the Company or any Significant
Subsidiary, by any court of competent jurisdiction, approving a petition seeking liquidation or reorganization of the Company or
any Subsidiary, or appointing a receiver, trustee, custodian or liquidator of the Company or any Subsidiary, or of all or any substantial
part of its assets, and such order, judgment or decree shall continue unstayed and in effect for any period of ninety (90) days;

 

xi.                   
the occurrence of any levy upon or seizure or attachment of, or any uninsured loss of or damage to, any property of the
Company or any Subsidiary having an aggregate fair value or repair cost (as the case may be) in excess of $100,000 individually
or in the aggregate, and any such levy, seizure or attachment shall not be set aside, bonded or discharged within thirty (30) days
after the date thereof; or

 

xii.                   
any monetary judgment, writ or similar final process shall be entered or filed against the Company, any subsidiary or any
of their respective property or other assets for more than $50,000, and such judgment, writ or similar final process shall remain
unvacated, unbonded or unstayed for a period of 45 calendar days.

 

 

 

    	 	10	 

     

    

 

b)              
Remedies Upon Event of Default. If any Event of Default occurs, then the outstanding principal amount of this Note, plus
accrued but unpaid interest, liquidated damages and other amounts owing in respect thereof through the date of acceleration, shall
become, at the Holder’s election made during the existence of the Event of Default and within thirty (30) days following
the occurrence of the Event of Default, immediately due and payable in cash at the Mandatory Default Amount. After the occurrence
of any Event of Default that results in the eventual acceleration of this Note, the interest rate on this Note shall accrue at
an additional interest rate equal to the lesser of 2% per month (24% per annum) or the maximum rate permitted under applicable
law. Upon the payment in full of the Mandatory Default Amount, the Holder shall promptly surrender this Note to or as directed
by the Company. In connection with such acceleration described herein, the Holder need not provide, and the Company hereby waives,
any presentment, demand, protest or other notice of any kind, and the Holder may immediately and without expiration of any grace
period enforce any and all of its rights and remedies hereunder and all other remedies available to it under applicable law. Such
acceleration may be rescinded and annulled by Holder at any time prior to payment hereunder and the Holder shall have all rights
as a holder of the Note until such time, if any, as the Holder receives full payment pursuant to this Section 6(b). No such rescission
or annulment shall affect any subsequent Event of Default or impair any right consequent thereon.

 

Section 7.       Representations
and Warranties of Holders.

 

a)       Organization;
Authority. Each Holder is an individual with full right, power and authority to enter into and to consummate the transactions
contemplated by this Note and otherwise to carry out its obligations hereunder and thereunder. The execution and delivery of the
Note and performance by such Purchaser of the transactions contemplated by the Note have been duly authorized by all necessary
corporate, partnership, limited liability company or similar action, as applicable, on the part of such Holder. The Note has been
duly executed by such Holder, and when delivered by such Holder in accordance with the terms hereof, will constitute the valid
and legally binding obligation of such Holder, enforceable against Holder in accordance with its terms, except: (i) as limited
by general equitable principles and applicable bankruptcy, insolvency, reorganization, moratorium and other laws of general application
affecting enforcement of creditors’ rights generally, (ii) as limited by laws relating to the availability of specific performance,
injunctive relief or other equitable remedies and (iii) insofar as indemnification and contribution provisions may be limited by
applicable law.

 

b)       Own
Account. Such Holder understands that the Securities are “restricted securities” and have not been registered under
the Securities Act or any applicable state securities law and is acquiring the Securities as principal for its own account and
not with a view to or for distributing or reselling such Securities or any part thereof in violation of the Securities Act or any
applicable state securities law, has no present intention of distributing any of such Securities in violation of the Securities
Act or any applicable state securities law and has no direct or indirect arrangement or understandings with any other persons to
distribute or regarding the distribution of such Securities in violation of the Securities Act or any applicable state securities
law (this representation and warranty not limiting such Holder’s right to sell the Securities pursuant to any registration
statement or otherwise in compliance with applicable federal and state securities laws). Such Holder is acquiring the Securities
hereunder in the ordinary course of its business.

 

c)       Holder
Status. At the time such Holder was offered the Securities, it was, and as of the date hereof it is, and on each date on which
it converts any Notes it will be an “accredited investor” as defined in Rule 501(a)(1), (a)(2), (a)(3), (a)(7) or (a)(8)
under the Securities Act.

 

d)       Experience
of Such Holder. Such Holder, either alone or together with its representatives, has such knowledge, sophistication and experience
in business and financial matters so as to be capable of evaluating the merits and risks of the prospective investment in the Securities,
and has so evaluated the merits and risks of such investment. Such Holder is able to bear the economic risk of an investment in
the Securities and, at the present time, is able to afford a complete loss of such investment.

 

Section 8.        Miscellaneous.

 

a)              
Notices. Any and all notices or other communications or deliveries to be provided by the Holder hereunder, including, without
limitation, any Notice of Conversion, shall be in writing and delivered personally, by facsimile, or sent by a nationally recognized
overnight courier service, addressed to the Company, at the address set forth above, or such other facsimile number or address
as the Company may specify for such purposes by notice to the Holder delivered in accordance with this Section 8(a). Any and all
notices or other communications or deliveries to be provided by the Company hereunder shall be in writing and delivered personally,
by facsimile, or sent by a nationally recognized overnight courier service addressed to each Holder at the facsimile number or
address of the Holder appearing on the books of the Company, or if no such facsimile number or address appears on the books of
the Company, at the principal place of business of such Holder, as set forth on the books and records of the Company. Any notice
or other communication or deliveries hereunder shall be deemed given and effective on the earliest of (i) the date of transmission,
if such notice or communication is delivered via facsimile at the facsimile number set forth on the signature pages attached hereto
prior to 5:30 p.m. (New York City time) on any date, (ii) the next Trading Day after the date of transmission, if such notice or
communication is delivered via facsimile at the facsimile number set forth on the signature pages attached hereto on a day that
is not a Trading Day or later than 5:30 p.m. (New York City time) on any Trading Day, (iii) the second Trading Day following the
date of mailing, if sent by U.S. nationally recognized overnight courier service or (iv) upon actual receipt by the party to whom
such notice is required to be given.

 

 

 

    	 	11	 

     

    

 

b)              
Absolute Obligation. Except as expressly provided herein, no provision of this Note shall alter or impair the obligation
of the Company, which is absolute and unconditional, to pay the principal of, liquidated damages and accrued interest, as applicable,
on this Note at the time, place, and rate, and in the coin or currency, herein prescribed. This Note is a direct debt obligation
of the Company. This Note ranks pari passu with all other Notes now or hereafter issued under the terms set forth herein.

 

c)              
Lost or Mutilated Note. If this Note shall be mutilated, lost, stolen or destroyed, the Company shall execute and deliver,
in exchange and substitution for and upon cancellation of a mutilated Note, or in lieu of or in substitution for a lost, stolen
or destroyed Note, a new Note for the principal amount of this Note so mutilated, lost, stolen or destroyed, but only upon receipt
of evidence of such loss, theft or destruction of such Note, and of the ownership hereof, reasonably satisfactory to the Company.

 

d)              
Governing Law. All questions concerning the construction, validity, enforcement and interpretation of this Note shall be
governed by and construed and enforced in accordance with the internal laws of the State of New York, without regard to the principles
of conflict of laws thereof. Each party agrees that all legal proceedings concerning the interpretation, enforcement and defense
of the transactions contemplated by any of the Transaction Documents (whether brought against a party hereto or its respective
Affiliates, directors, officers, shareholders, employees or agents) shall be commenced in the state and federal courts sitting
in the City of New York, Borough of Manhattan (the “New York Courts”). Each party hereto hereby irrevocably
submits to the exclusive jurisdiction of the New York Courts for the adjudication of any dispute hereunder or in connection herewith
or with any transaction contemplated hereby or discussed herein (including with respect to the enforcement of any of the Transaction
Documents), and hereby irrevocably waives, and agrees not to assert in any suit, action or proceeding, any claim that it is not
personally subject to the jurisdiction of such New York Courts, or such New York Courts are improper or inconvenient venue for
such proceeding. Each party hereby irrevocably waives personal service of process and consents to process being served in any such
suit, action or proceeding by mailing a copy thereof via registered or certified mail or overnight delivery (with evidence of delivery)
to such party at the address in effect for notices to it under this Note and agrees that such service shall constitute good and
sufficient service of process and notice thereof. Nothing contained herein shall be deemed to limit in any way any right to serve
process in any other manner permitted by applicable law. Each party hereto hereby irrevocably waives, to the fullest extent permitted
by applicable law, any and all right to trial by jury in any legal proceeding arising out of or relating to this Note or the transactions
contemplated hereby. If any party shall commence an action or proceeding to enforce any provisions of this Note, then the prevailing
party in such action or proceeding shall be reimbursed by the other party for its attorneys’ fees and other costs and expenses
incurred in the investigation, preparation and prosecution of such action or proceeding.

 

e)              
Waiver. Any waiver by the Company or the Holder of a breach of any provision of this Note shall not operate as or be construed
to be a waiver of any other breach of such provision or of any breach of any other provision of this Note. The failure of the Company
or the Holder to insist upon strict adherence to any term of this Note on one or more occasions shall not be considered a waiver
or deprive that party of the right thereafter to insist upon strict adherence to that term or any other term of this Note on any
other occasion. Any waiver by the Company or the Holder must be in writing.

 

f)               
Severability. If any provision of this Note is invalid, illegal or unenforceable, the balance of this Note shall remain
in effect, and if any provision is inapplicable to any Person or circumstance, it shall nevertheless remain applicable to all other
Persons and circumstances. If it shall be found that any interest or other amount deemed interest due hereunder violates the applicable
law governing usury, the applicable rate of interest due hereunder shall automatically be lowered to equal the maximum rate of
interest permitted under applicable law. The Company covenants (to the extent that it may lawfully do so) that it shall not at
any time insist upon, plead, or in any manner whatsoever claim or take the benefit or advantage of, any stay, extension or usury
law or other law which would prohibit or forgive the Company from paying all or any portion of the principal of or interest on
this Note as contemplated herein, wherever enacted, now or at any time hereafter in force, or which may affect the covenants or
the performance of this Note, and the Company (to the extent it may lawfully do so) hereby expressly waives all benefits or advantage
of any such law, and covenants that it will not, by resort to any such law, hinder, delay or impede the execution of any power
herein granted to the Holder, but will suffer and permit the execution of every such as though no such law has been enacted.

 

 

 

    	 	12	 

     

    

 

g)              
Remedies, Characterizations, Other Obligations, Breaches and Injunctive Relief.  The remedies provided in this Note
shall be cumulative and in addition to all other remedies available under this Note and any of the other Transaction Documents
at law or in equity (including a decree of specific performance and/or other injunctive relief), and nothing herein shall limit
the Holder’s right to pursue actual and consequential damages for any failure by the Company to comply with the terms of
this Note.  The Company covenants to the Holder that there shall be no characterization concerning this instrument other than
as expressly provided herein. Amounts set forth or provided for herein with respect to payments, conversion and the like (and the
computation thereof) shall be the amounts to be received by the Holder and shall not, except as expressly provided herein, be subject
to any other obligation of the Company (or the performance thereof). The Company acknowledges that a breach by it of its obligations
hereunder will cause irreparable harm to the Holder and that the remedy at law for any such breach may be inadequate. The Company
therefore agrees that, in the event of any such breach or threatened breach, the Holder shall be entitled, in addition to all other
available remedies, to an injunction restraining any such breach or any such threatened breach, without the necessity of showing
economic loss and without any bond or other security being required. The Company shall provide all information and documentation
to the Holder that is requested by the Holder to enable the Holder to confirm the Company’s compliance with the terms and
conditions of this Note.

 

h)              
Next Business Day. Whenever any payment or other obligation hereunder shall be due on a day other than a Business Day, such
payment shall be made on the next succeeding Business Day.

 

i)               
Headings. The headings contained herein are for convenience only, do not constitute a part of this Note and shall not be
deemed to limit or affect any of the provisions hereof.

 

j)               
Secured Obligation. The obligations of the Company under this Note are secured by all assets of the Company and each Subsidiary
pursuant to the Security Agreement, dated as of September [•], 2019 between
the Company, the Subsidiaries of the Company and the Secured Parties (as defined therein).

 

 

 

 

 

 

    	 	13	 

     

    

 

IN WITNESS WHEREOF,
the Company has caused this Note to be duly executed by a duly authorized officer as of the date first above indicated.

 

 

	
        MOBIQUITY TECHNOLOGIES,
        INC.

         

         

	
        By: /s/ Dean Julia

        Name: Dean Julia

        Title: CEO

        Facsimile No. for delivery of Notices: 516-256-7805

	 
	 

	
        HOLDER:

         

         

	
        MARITAL TRUST GST SUBJECT U/W/O
        LEOPOLD SALKIND

         

        By: /s/ Gene Salkind

        Gene Salkind,
        Trustee

         

	 
	 

 

 

 

 

 

 

    	 	14	 

     

    

 

 

Schedule 6(a)(iii)

 

The Company is in default on loans totaling
$150,000 which are unsecured.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    	 	15	 

     

    

 

ANNEX A

 

NOTICE OF CONVERSION

 

 

The undersigned hereby
elects to convert principal under the 15% Senior Secured Convertible Promissory Note due September 30, 2029 of Mobiquity Technologies,
Inc., a New York corporation (the “Company”), into shares of common stock (the “Common Stock”),
of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in
the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is
delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will
be charged to the holder for any conversion, except for such transfer taxes, if any.

 

The undersigned agrees
to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the
aforesaid shares of Common Stock.

 

Conversion calculations:

	 	Date to Effect Conversion:
	 	 
	 	Principal Amount of Note to be Converted:
	 	 
	 	Payment of Interest in Common Stock __ yes  __ no
	 	If yes, $_____ of Interest Accrued on Account of Conversion at Issue.
	 	 
	 	Number of shares of Common Stock to be issued:
	 	 
	 	 
	 	Signature:
	 	 
	 	Name:
	 	 
	 	DWAC Instructions:
	 	 
	 	Broker
    No:____________
	 	Account
    No:_____________

 

 

 

 

 

 

    	 	16Exhibit 10.10

 

COMMON STOCK PURCHASE WARRANT

 

THE WARRANTS REPRESENTED BY THIS CERTIFICATE
AND THE SECURITIES ISSUABLE UPON EXERCISE THEREOF HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”),
AND MAY NOT BE OFFERED OR SOLD EXCEPT (i) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE ACT, (ii) TO THE EXTENT APPLICABLE,
PURSUANT TO RULE 144 UNDER SUCH ACT (OR ANY SIMILAR RULE UNDER SUCH ACT RELATING TO THE DISPOSITION OF SECURITIES), OR (iii) UPON
THE DELIVERY BY THE HOLDER TO THE COMPANY OF AN OPINION OF COUNSEL, REASONABLY SATISFACTORY TO COUNSEL FOR THE COMPANY, STATING
THAT AN EXEMPTION FROM REGISTRATION UNDER SUCH ACT IS AVAILABLE.

 

 

 

Warrant 

 

Mobiquity Technologies, Inc.

 

This warrant certificate
(the “Warrant Certificate”) certifies that____________________, or registered assigns, is the registered holder (the
“Holder”) of Warrants to purchase, at any time until 5:00 P.M. New York time on September 30, 2029 (the “Expiration
Date”), up to ________ fully-paid and non-assessable shares, subject to adjustment in accordance with Article 4 hereof (the
“Warrant Shares”), of the common stock, par value $.0001 per share (the “Common Stock”), of Mobiquity
Technologies, Inc., a New York corporation (the “Company”), subject to the terms and conditions set forth herein.
The Warrants represented by this Warrant Certificate and any warrants resulting from a transfer or subdivision of the warrants
represented by this Warrant Certificate shall sometimes hereinafter be referred to, individually, as a “Warrant” and,
collectively, as the “Warrants.”

 

The term “Warrant”
as used herein, shall include this Warrant, and any warrants delivered in substitution or exchange therefor as provided herein.

 

1.       Exercise
of Warrants. This Warrant is initially exercisable to purchase one Warrant Share at an initial exercise price of $.12 per share
(the “Initial Exercise Price”), subject to adjustment as set forth in Article 4 hereof, payable in cash or by check
to the order of the Company, or any combination of cash or check. (Note: The “Exercise Price” shall mean the
Initial Exercise Price or the adjusted exercise price, depending upon the context.) Upon surrender of this Warrant Certificate
with the annexed Form of Election to Purchase duly executed, together with payment of the Exercise Price (as hereinafter defined)
for the Warrant Shares purchased, at the Company's principal offices, the registered holder of the Warrant Certificate (the “Holder”
or “Holders”) shall be entitled to receive a certificate or certificates for the Warrant Shares so purchased. The purchase
rights represented by this Warrant Certificate are exercisable at the option of the Holder hereof, in whole or in part (but not
as to fractional shares). In the case of the purchase of less than all the Warrant Shares purchasable under this Warrant Certificate,
the Company shall cancel this Warrant Certificate upon its surrender and shall execute and deliver a new Warrant Certificate of
like tenor for the balance of the Warrant Shares purchasable hereunder.

 

This Warrant shall
be deemed to have been exercised immediately prior to the close of business on the date of its surrender for exercise as provided
above, and the person entitled to receive the Warrant Shares issuable upon such exercise shall be treated for all purposes as the
holder of record of such securities as of the close of business on such date. As promptly as practicable on or after such date
and in any event within five (5) business days after such date, the Company at its expense shall issue and deliver, to the person
or persons entitled to receive them, certificates and/or instruments representing the Warrant Shares as to which the Holder has
so exercised this Warrant in the name of the Holder or its designee. In the event that this Warrant is exercised in part, the Company
at its expense will execute and deliver a new Warrant of like tenor exercisable for the number of Warrant Shares for which this
Warrant has not been exercised.

 

The Company hereby
represents and warrants that the Warrant Shares issuable upon the exercise of this Warrant, when issued, sold and delivered, will
be duly and validly authorized and issued, fully paid and nonassessable and free from all taxes, liens and charges in respect of
the issuance thereof (other than liens or charges created by or imposed upon the recipient of the Warrant Shares).

 

 

 

    	 	1	 

     

    

 

2.       Issuance
of Certificates. Upon the exercise of the Warrants, the issuance of certificates for the Warrant Shares purchased pursuant
to such exercise shall be made within five business days without charge to the Holder thereof including, without limitation, any
tax which may be payable in respect of the issuance thereof, and such certificates shall (subject to the provisions of Article
3 hereof) be issued in the name of, or in such names as may be directed by, the Holder thereof; provided, however, that the Company
shall not be required to pay any tax which may be payable in respect of any transfer involved in the issuance and delivery of any
such certificates in a name other than that of the Holder and the Company shall not be required to issue or deliver such certificates
unless or until the person or persons requesting the issuance thereof shall have paid to the Company the amount of such tax or
shall have established to the satisfaction of the Company that such tax has been paid.

 

The Warrant Certificates
and, upon exercise of the Warrants, the certificates representing the Warrant Shares shall be executed on behalf of the Company
by the manual or facsimile signature of those officers required to sign such certificates under applicable law.

 

This Warrant Certificate
and, upon exercise of the Warrants, in part or in whole, certificates representing the Warrant Shares shall bear a legend substantially
similar to the following:

 

The securities represented by this
certificate have not been registered under the Securities Act of 1933, as amended (“Act”), and may not be offered or
sold except (i) pursuant to an effective registration statement under the Act, (ii) to the extent applicable, pursuant to Rule
144 under the Act (or any similar rule under such Act relating to the disposition of securities), or (iii) upon the delivery by
the holder to the Company of an opinion of counsel, reasonably satisfactory to counsel to the issuer, stating that an exemption
from registration under such Act is available. 

 

3.       Restriction
on Transfer of Warrants and Warrant Shares. The Holder of this Warrant Certificate, by its acceptance thereof, represents and
warrants to, and covenants and agrees with the Company that the Warrants and the Warrant Shares issuable upon exercise of the Warrants
are being acquired for the Holder's own account as an investment and not with a view to the resale or distribution thereof and
that the Warrants and the Warrant Shares are not registered under the Act or any state securities or blue sky laws and, therefore,
may not be transferred unless such securities are either registered under the Act and any applicable state securities law or an
exemption from such registration is available. The Holder of this Warrant Certificate acknowledges that the Holder is an “accredited
investor” within the meaning of Regulation D promulgated under the Act who has been provided with an opportunity to ask questions
of representatives of the Company concerning the Company and that all such questions were answered to the satisfaction of the Holder.
In connection with any purchase of Warrant Shares the Holder agrees to execute any documents which may be reasonably required by
counsel to the Company to comply with the provisions of the Act and applicable state securities laws.

 

4.       Adjustments
of Exercise Price and Number of Warrant Shares.

 

4.1       Dividends
and Distributions. If at any time prior to the Expiration Date, the Company shall pay a dividend in shares of Common Stock
or make a distribution in shares of Common Stock, then upon such dividend or distribution, the Exercise Price in effect immediately
prior to such dividend or distribution shall be reduced to a price determined by dividing an amount equal to the total number of
shares of Common Stock outstanding immediately prior to such dividend or distribution multiplied by the Exercise Price in effect
immediately prior to such dividend or distribution, by the total number of shares of Common Stock outstanding immediately after
such dividend or distribution. For purposes of any computation to be made in accordance with the provisions of this Section 4.1,
the Common Stock issuable by way of dividend or distribution shall be deemed to have been issued immediately after the opening
of business on the date following the date fixed for determination of shareholders entitled to receive such dividend or distribution.
Upon each adjustment of the Exercise Price pursuant to the provisions of this Article 4.1, the number of Warrant Shares issuable
upon the exercise of each Warrant shall be adjusted to the nearest full share of Common Stock by multiplying a number equal to
the Exercise Price in effect immediately prior to such adjustment by the number of Warrant Shares issuable upon exercise of the
Warrants immediately prior to such adjustment and dividing the product so obtained by the adjusted Exercise Price.

 

4.2       Subdivision
and Combination. If at any time prior to the Expiration Date, the Company shall subdivide (by any stock split, stock dividend,
recapitalization, reorganization, reclassification or otherwise) the shares of Common Stock subject to acquisition hereunder into
a greater number of shares, then, after the date of record for effecting such subdivision, the Exercise Price in effect immediately
prior to such subdivision will be proportionately reduced and the number of shares of Common Stock subject to acquisition upon
exercise of this Warrant will be proportionately increased. If the Company at any time combines (by reverse stock split, recapitalization,
reorganization, reclassification or otherwise) the shares of Common Stock subject to acquisition hereunder into a lesser number
of shares, then, after the date of record for effecting such combination, the Exercise Price in effect immediately prior to such
combination will be proportionately increased and the number of shares of Common Stock subject to acquisition upon exercise of
this Warrant will be proportionately decreased.

 

 

 

    	 	2	 

     

    

 

4.3       Reorganization,
Merger or Sale of Assets If, at any time prior to the Expiration Date, there shall be (i) a reorganization (other than a combination,
reclassification, exchange or subdivision of shares otherwise provided for herein), (ii) a merger or consolidation of the Company
with or into another corporation in which the Company is not the surviving entity, or (iii) a sale or transfer of the Company’s
properties and assets in, or substantially in, their entirety to any other person, then, as a part of such reorganization, merger,
consolidation, sale or transfer, lawful provision shall be made so that the Holder shall thereafter be entitled to receive upon
payment of the Exercise Price then in effect, the number of shares of stock or other securities or property of the successor or
corporation resulting from such reorganization, merger, consolidation, sale or transfer that a holder of the shares of Common Stock
deliverable upon exercise of this Warrant would have been entitled to receive in such reorganization, consolidation, merger, sale
or transfer if this Warrant had been exercised immediately before such reorganization, merger, consolidation, sale or transfer.
If the per-share consideration payable to the Holder for shares in connection with any such transaction is in a form other than
cash or marketable securities, then the value of such consideration shall be determined in good faith by the Company’s Board
of Directors. In all events, appropriate adjustment (as determined in good faith by the Company’s Board of Directors) shall
be made in the application of the provisions of this Warrant with respect to the rights and interests of the Holder after the transaction,
to the end that the provisions of this Warrant shall be applicable after that event, as near as reasonably may be, in relation
to any shares or other property deliverable after that event upon exercise of this Warrant. Notwithstanding the above, in the event
the sale or merger of the Company is consummated by means of an all cash transaction whereby the Company’s Common Stock will
cease to be outstanding, this Warrant must be exercised prior to the close of such transaction or it will be cashed out for the
consideration paid to holders of Common Stock in the transaction less the Exercise Price.

 

4.4       Notice
of Adjustments. Upon any adjustment of the Exercise Price, then and in each such case the Company shall give notice thereof
to the Holder, which notice shall state the Exercise Price resulting from such adjustment and the increase or decrease, if any,
in the number of Warrant Shares purchasable at such price upon the exercise of this Warrant, setting forth in reasonable detail
the method of calculation and the facts upon which such calculation is based.

 

4.5       Determination
of Outstanding Shares. The number of shares of Common Stock at any one time outstanding shall include the aggregate number
of shares issued or issuable upon the exercise of outstanding options, rights, warrants and upon the conversion or exchange of
outstanding convertible or exchangeable securities.

 

5.       Exchange
and Replacement of Warrant Certificates. This Warrant Certificate is exchangeable without expense, upon the surrender hereof
by the registered Holder at the principal executive office of the Company, for a new Warrant Certificate of like tenor and date
representing in the aggregate the right to purchase the same number of Warrant Shares in such denominations as shall be designated
by the Holder thereof at the time of such surrender.

 

Upon receipt by the
Company of evidence reasonably satisfactory to it of the loss, theft, destruction or mutilation of this Warrant Certificate, and,
in case of loss, theft or destruction, of indemnity or security reasonably satisfactory to it, and reimbursement to the Company
of all reasonable expenses incidental thereto, and upon surrender and cancellation of the Warrants, if mutilated, the Company will
make and deliver a new Warrant of like tenor, in lieu thereof.

 

6.       Elimination
of Fractional Interests. The Company shall not be required to issue certificates representing fractions of shares of Common
Stock and shall not be required to issue scrip or pay cash in lieu of fractional interests, it being the intent of the parties
that all fractional interests shall be eliminated by rounding any fraction up to the nearest whole number of shares of Common Stock.

 

7.       Reservation
of Shares. The Company covenants and agrees that it will at all times reserve and keep available out of its authorized share
capital, solely for the purpose of issuance upon the exercise of the Warrants, such number of shares of Common Stock as shall be
equal to the number of Warrant Shares issuable upon the exercise of the Warrants, for issuance upon such exercise, and that, upon
exercise of the Warrants and payment of the Exercise Price therefor, all Warrant Shares issuable upon such exercise shall be duly
and validly issued, fully paid, nonassessable and not subject to the preemptive rights of any shareholder.

 

8.       Notices
to Warrant Holders. Nothing contained in this Agreement shall be construed as conferring upon the Holder or Holders the right
to vote or to consent or to receive notice as a stockholder in respect of any meetings of stockholders for the election of directors
or any other matter, or as having any rights whatsoever as a shareholder of the Company. If, however, at any time prior to the
expiration of the Warrants and their exercise, any of the following events shall occur:

 

 

 

    	 	3	 

     

    

 

(a)       the
Company shall take a record of the holders of its Common Stock for the purpose of entitling them to receive a dividend or distribution
payable otherwise than in cash, or a cash dividend or distribution payable otherwise then out of current or retained earnings,
as indicated by the accounting treatment of such dividend or distribution on the books of the Company; or

 

(b)       the
Company shall offer to all the holders of its Common Stock any additional shares of Common Stock or other shares of capital stock
of the Company or securities convertible into or exchangeable for shares of Common Stock or other shares of capital stock of the
Company, or any option, right or warrant to subscribe therefor;

 

(c)       a
dissolution, liquidation or winding up of the Company (other than in connection with a consolidation or merger) or a sale of all
or substantially all of its property, assets and business as an entirety shall be proposed; or

 

(d)       the
Company or an affiliate of the Company shall propose to issue any rights to subscribe for shares of Common Stock or any other securities
of the Company or of such affiliate to all the stockholders of the Company;

 

then, in any one or more of said events,
the Company shall give written notice of such event at least twenty (20) days prior to the date fixed as a record date or the date
of closing the transfer books for the determination of the stockholders entitled to such dividend, distribution, convertible or
exchangeable securities or subscription rights, options or warrants, or entitled to vote on such proposed dissolution, liquidation,
winding up or sale. Such notice shall specify such record date or the date of closing the transfer books, as the case may be. Failure
to give such notice or any defect therein shall not affect the validity of any action taken in connection with the declaration
or payment of any such dividend or distribution, or the issuance of any convertible or exchangeable securities or subscription
rights, options or warrants, or any proposed dissolution, liquidation, winding up or sale.

 

9.Notices.All notices,
requests, consents and other communications hereunder shall be in writing and shall be deemed to have been duly made when delivered,
or mailed by registered or certified mail, return receipt requested:

 

(a)       If
to a registered Holder of the Warrants, to the address of such Holder as shown on the books of the Company; or

 

(b)       If
to the Company, to the address set forth in Article 1 of this Agreement or to such other address as the Company may designate by
notice to the Holders.

 

10.       Successors.
All the covenants and provisions of this Agreement by or for the benefit of the Company and the Holders inure to the benefit of
their respective successors and assigns hereunder.

 

 

11.Governing Law.

 

11.1       
Choice of Law. This Agreement shall be deemed to have been made and delivered in the State of New York and shall be governed
as to validity, interpretation, construction, effect and in all other respects by the internal laws of the State of New York.

 

11.2       
Jurisdiction and Service of Process. The Company and the Holder each (a) agrees that any legal suit, action or proceeding
arising out of or relating to this Warrant Certificate shall be instituted exclusively in the Supreme Court of New York, New York,
New York, or in the United States District Court for the Southern District of New York, New York (b) waives any objection which
the Company or such Holder may have now or hereafter based upon forum non conveniens or to the venue of any such suit, action
or proceeding, and (c) irrevocably consents to the jurisdiction of the Supreme Court of New York, New York, New York, or in the
United States District Court for the Southern District of New York, New York in any such suit, action or proceeding. The Company
and the Holder each further agrees (a) to accept and acknowledge service of any and all process which may be served in any such
suit, action or proceeding in the Supreme Court of New York, New York, New York, or in the United States District Court for the
Southern District of New York, New York and (b) agrees that service of process upon the Company or the Holder mailed by certified
mail to their respective addresses shall be deemed in every respect effective service of process upon the Company or the Holder,
as the case may be, in any suit, action or proceeding. FURTHER, BOTH THE COMPANY AND HOLDER HEREBY WAIVE TRIAL BY JURY IN ANY ACTION
TO ENFORCE THE TERMS OF THIS WARRANT CERTIFICATE AND IN CONNECTION WITH ANY DEFENSE, COUNTERCLAIM OR CROSS-CLAIM ASSERTED IN ANY
SUCH ACTION.

 

 

 

    	 	4	 

     

    

 

 

IN WITNESS WHEREOF, the Company has caused
this Warrant to be duly executed, as of the _____ day of September , 2019.

 

 

	 	MOBIQUITY TECHNOLOGIES, INC.
	 	 
	 	 
	 	By:                                             
	 	       Dean L. Julia, Chief Executive Officer

 

 

 

 

 

 

    	 	5	 

     

    

 

[FORM OF ELECTION TO PURCHASE]

 

 

(1)  
The undersigned hereby elects to purchase ________ Warrant Shares of the Company pursuant to the terms of the attached Warrant
(only if exercised in full), and tenders herewith payment of the exercise price in full, together with all applicable transfer
taxes, if any.

(2)  
Please issue a certificate or certificates representing said Warrant Shares in the name of the undersigned or in such other
name as is specified below:

 

___________________________________________,
whose address is ________________ ____________________________________________________________, and that such certificate be delivered
to ___________________, whose address is ____________________ ___________________________.

 

 

	Dated:                           	Signature: _______________________________
	  	   (Signature must conform in all respects to
	 	    name of holder as specified on the face of 
	 	    the Warrant Certificate.)
	 	 

 

_________________________________

 

_________________________________

(Insert Social Security or Other

Identifying Number of Holder)

 

 

 

 

 

    	 	6	 

     

    

 

ASSIGNMENT FORM

 

The undersigned, being the true and lawful owner of Holder Warrants
to purchase shares of Common Stock of Mobiquity Technologies, Inc. hereby assigns and transfers unto:

 

 

	Name:	                                                                    
	 	(Please typewrite or print in block letters)
	 	 
	 	 
	Address:	                                                                     
	 	 
	 	                                                                    
	 	 
	 	                                                                    
	 	 
	 	Social Security Number/ Federal ID:                                           
	 	 

 

the right to purchase Common Stock of _____________ represented
by this Warrant to the extent of shares of Common Stock as to which such right is exercisable and does hereby irrevocably constitute
and appoint __________________________ ___________________ Attorney, to transfer the same on the books of Mobiquity Technologies,
Inc. with full power of substitution in the premises.

 

 

Dated: ___________________

 

	 	 
	 	______________________________
	 	Name of Registered Holder
	 	 
	 	 
	 	______________________________
	 	Signature
	 	 
	 	______________________________
	 	Signature, if held jointly

 

 

 

 

    	 	7

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