Document:

EXHIBIT 10.2

 

PURSUANT
TO THE TERMS OF SECTION 1 OF THIS WARRANT, ALL OR A PORTION OF THIS WARRANT MAY HAVE BEEN EXERCISED, AND THEREFORE THE ACTUAL NUMBER
OF WARRANT SHARES REPRESENTED BY THIS WARRANT MAY BE LESS THAN THE AMOUNT SET FORTH ON THE FACE HEREOF.

 

INTELLINETICS,
INC.

 

Warrant No. XXX

 

WARRANT
TO PURCHASE COMMON STOCK

 

VOID AFTER 5:00 P.M., EASTERN TIME,

ON THE EXPIRATION DATE

 

THIS WARRANT AND ANY SHARES ACQUIRED UPON
THE EXERCISE OF THIS WARRANT HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), AND
MAY NOT BE SOLD, PLEDGED, HYPOTHECATED, DONATED OR OTHERWISE TRANSFERRED WITHOUT COMPLIANCE WITH THE REGISTRATION OR QUALIFICATION
PROVISIONS OF APPLICABLE FEDERAL AND STATE SECURITIES LAWS OR WITHOUT DELIVERING AN OPINION OF COUNSEL REASONABLY SATISFACTORY
TO THE COMPANY THAT SUCH REGISTRATION IS NOT REQUIRED.

 

FOR VALUE RECEIVED, Intellinetics,
Inc., a Nevada corporation (the “Company”), hereby agrees to sell upon the terms and on the conditions
hereinafter set forth, at any time commencing on the date hereof but no later than 5:00 p.m., Eastern Time, on December 1, 2021
(the “Expiration Date”), to [NAME], or his, her or its registered assigns (the “Holder”),
under the terms as hereinafter set forth, [AMOUNT] (XXXX) fully paid and non-assessable shares of the Company’s Common Stock,
par value $0.001 per share (the “Common Stock”), at a purchase price per share of $X.XX (the “Warrant
Price”), pursuant to the terms and conditions set forth in this warrant (this “Warrant”).
The number of shares of Common Stock issued upon exercise of this Warrant (“Warrant Shares”) and the
Warrant Price are subject to adjustment in certain events as hereinafter set forth.

 

This Warrant is issued
in conjunction with a Convertible Promissory Note issued by the Company to the Holder dated November 30, 2016.

 

1.             Exercise of Warrant.

 

(a)                
The Holder may exercise this Warrant according to the terms and conditions set forth herein by delivering to the Company
(whether via facsimile or otherwise) at any time prior to the Expiration Date (such date of exercise, the “Exercise
Date”) (i) the Exercise Notice attached hereto as Exhibit A (the “Exercise Notice”)
(having then been duly executed by the Holder), and (ii) unless the Warrant is being exercised pursuant to a Cashless Exercise
(as defined below), cash, a certified check, a bank draft or wire transfer in payment of the purchase price, in lawful money of
the United States of America, for the number of Warrant Shares specified in the Exercise Form. The Holder shall not be required
to deliver the original of this Warrant in order to effect an exercise hereunder. Execution and delivery of an Exercise Form with
respect to less than all of the Warrant Shares shall have the same effect as cancellation of the original of this Warrant and issuance
of a new Warrant evidencing the right to purchase the remaining number of Warrant Shares. Execution and delivery of an Exercise
Form for all of the then-remaining Warrant Shares shall have the same effect as cancellation of the original of this Warrant after
delivery of the Warrant Shares in accordance with the terms hereof.

 

    	 

     

    

 

(b)                
On or before the second (2nd) Trading Day following the later of (i) the date on which the Company has received
an Exercise Notice or (ii) the date on which the Company receives payment of the exercise price (which shall not apply for cashless
exercises), the Company shall transmit an acknowledgment of confirmation of receipt of such Exercise Notice to the Holder and the
Company’s transfer agent (the “Transfer Agent”). On or before the third (3rd) Trading
Day following the later of (i) the date on which the Company has received such Exercise Notice or (ii) the date on which the Company
receives the exercise price (which shall not apply for cashless exercises) (such later date, the “Delivery Date”),
the Company shall (X) provided that the Transfer Agent is participating in The Depository Trust Company (“DTC”)
Fast Automated Securities Transfer Program, upon the request of the Holder, credit such aggregate number of shares of Common Stock
to which the Holder is entitled pursuant to such exercise to the Holder’s or its designee’s balance account with DTC
through its Deposit/ Withdrawal at Custodian system, or (Y) if the Transfer Agent is not participating in the DTC Fast Automated
Securities Transfer Program, issue and deliver to the Holder or, at the Holder’s instruction pursuant to the Exercise Notice,
the Holder’s agent or designee, in each case, sent by reputable overnight courier to the address as specified in the applicable
Exercise Notice, a certificate, registered in the Company’s share register in the name of the Holder or its designee (as
indicated in the applicable Exercise Notice), for the number of shares of Common Stock to which the Holder is entitled pursuant
to such exercise. Upon the later of (i) the date on which the Company has received the Exercise Notice or (ii) the date on which
the Company receives the exercise price (which shall not apply for cashless exercises), the Holder shall be deemed for all corporate
purposes to have become the holder of record of the Warrant Shares with respect to which this Warrant has been exercised, irrespective
of the date such Warrant Shares are credited to the Holder’s DTC account or the date of delivery of the certificates evidencing
such Warrant Shares (as the case may be). Notwithstanding the foregoing, if a Holder has not received certificates for all Warrant
Shares prior to the fifth (5th) business day after the Delivery Date with respect to an exercise of any portion of this
Warrant for any reason, then Holder shall have the right, but not the obligation, at any time thereafter until receipt of all the
Warrant Shares relating to the Exercise Notice, to rescind the Exercise Notice by providing notice to the Company (the “Rescission
Notice”). Upon delivery of a Rescission Notice to the Company, the Holder shall regain the rights of a Holder of
this Warrant with respect to such unexercised portions of this Warrant and the Company shall, as soon as practicable, return such
unexercised Warrant to the Holder or, if the Warrant has not been surrendered, adjust its records to reflect that such portion
of this Warrant has not been exercised. In addition, if the Company fails to deliver to the Holder a certificate or certificates
representing the Warrant Shares pursuant to an exercise by the close of business on the fifth Trading Day after its receipt of
the Exercise Amount, and if after such fifth Trading Day the Holder is required by its broker to purchase (in an open market transaction
or otherwise) shares of Common Stock to deliver in satisfaction of a sale by the Holder of the Warrant Shares which the Holder
anticipated receiving upon such exercise (a “Buy-In”), then the Company shall (i) pay in cash to the
Holder the amount by which (x) the Holder’s total purchase price (including brokerage commissions, if any) for the shares
of Common Stock so purchased exceeds (y) the amount obtained by multiplying (A) the number of Warrant Shares that the Company was
required to deliver to the Holder in connection with the exercise at issue times (B) the price at which the sell order giving rise
to such purchase obligation was executed, or (ii) at the option of the Holder, either reinstate the portion of the Warrant and
equivalent number of Warrant Shares for which such exercise was not honored or deliver to the Holder the number of shares of Common
Stock that would have been issued had the Company timely complied with its exercise and delivery obligations hereunder.  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
exercise of Warrant Shares with an aggregate sale price giving rise to such purchase obligation of $10,000, under clause (i) 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, together with applicable confirmations and
other evidence reasonably requested by the Company. 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 Warrant Shares upon exercise of
this Warrant as required pursuant to the terms hereof.

 

(c)                
This Warrant may be exercised in whole or in part so long as any exercise in part hereof would not involve the issuance
of fractional Warrant Shares. If exercised in part, at the request of the Holder and upon delivery of the original Warrant, the
Company shall deliver to the Holder a new Warrant, identical in form to this Warrant, in the name of the Holder, evidencing the
right to purchase the number of Warrant Shares as to which this Warrant has not been exercised, which new Warrant shall be signed
by the President or Chief Executive Officer of the Company. The term Warrant as used herein shall include any subsequent Warrant
issued as provided herein.

 

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(d)                
Notwithstanding any provisions herein to the contrary, in lieu of exercising this Warrant by cash payment in the manner
set forth in Section 1(a), the Holder may, in its sole discretion, elect to exercise this Warrant, or a portion hereof, and to
pay for the Warrant Stock by way of cashless exercise (a “Cashless Exercise”). If the Holder wishes to
effect a cashless exercise, the Holder shall deliver the Exercise Notice duly executed by such Holder or by such Holder’s
duly authorized attorney, at the principal office of the Company, or at such other office or agency as the Company may designate
in writing prior to the date of such exercise, in which event the Company shall issue to the Registered Holder the number of Warrant
Shares computed according to the following equation:

 

 

; where

 

X = the number of Warrant
Shares to be issued to the Registered Holder.

 

Y = the Warrant Shares
purchasable under this Warrant or, if only a portion of the Warrant is being exercised, the portion of the Warrant Shares being
exercised.

 

A = the Fair Market Value
(defined below) of one share of Common Stock on the Exercise Date.

 

B = the Exercise Price
(as adjusted pursuant to the provisions of this Warrant).

 

For purposes of this
Section 1(d), the “Fair Market Value” of one share of Common Stock on the Exercise Date shall have one of the following
meanings:

 

(1)       if
the Common Stock is traded on a national securities exchange registered with the Securities Exchange Commission pursuant to the
Securities Exchange Act of 1934, as amended, the Fair Market Value shall be deemed to be the average of the Closing Prices over
a five trading day period immediately prior to the Exercise Date. For the purposes of this Warrant, “Closing Price”
means the closing sale price of one share of Common Stock, as reported by Bloomberg; or

 

(2)       if
the Common Stock is not traded on a national securities exchange, the Fair Market Value shall be deemed to be the average of the
closing bid prices price over the ten (10) trading day period ending immediately prior to the Exercise Date; or

 

(3)       if
neither (1) nor (2) is applicable, the Fair Market Value shall be at the commercially reasonable price per share which the Company
could obtain on the Exercise Date from a willing buyer (not a current employee or director) for shares of Common Stock sold by
the Company, from authorized but unissued shares, as determined in good faith by the Company’s Board of Directors.

 

For illustration purposes
only, if this Warrant entitles the Holder the right to purchase 100,000 Warrant Shares and the Holder were to exercise this Warrant
for 50,000 Warrant Shares at a time when the Exercise Price per share was $1.00 and the Fair Market Value of each share of Common
Stock was $2.00 on the Exercise Date, as applicable, the cashless exercise calculation would be as follows:

 

X = 50,000 ($2.00-$1.00)

2.00

 

X = 25,000

 

Therefore, the number
of Warrant Shares to be issued to the Holder after giving effect to the cashless exercise would be 25,000 Warrant Shares and this
Warrant would then entitle the Holder to purchase 50,000 Warrant Shares, reflecting the portion of this Warrant not exercised by
the Holder. For purposes of Rule 144 promulgated under the Securities Act of 1933, as amended (the “Securities Act”),
it is intended, understood and acknowledged that the Warrant Shares issued in the cashless exercise transaction described pursuant
to Section 1(c) shall be deemed to have been acquired by the Holder, and the holding period for the shares of Warrant Shares shall
be deemed to have commenced, on the date of the Holder’s acquisition of the Warrant.

 

(e)                
No fractional Warrant Shares or scrip representing fractional Warrant Shares shall be issued upon the exercise of this Warrant.
The Company shall pay cash in lieu of such fractional Warrant Shares. The price of a fractional Warrant Share shall equal the product
of (i) the closing price of the Common Stock on the exchange or market on which the Common Stock is then traded (if the Common
Stock is not then publicly traded, then upon the Fair Market Value per share of the Common Stock (as determined by the Company’s
Board of Directors)), and (ii) the applicable fraction.

 

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(f)                 
Except as provided in Section 4 hereof, the Company shall pay any and all documentary stamp or similar issue or transfer
taxes payable in respect of the issue or delivery of Warrant Shares on exercise of this Warrant.

 

(g)                
The Company will not close its stockholder books or records in any manner which prevents the timely exercise of this Warrant,
pursuant to the terms hereof.

 

2.             Disposition of Warrant Shares and Warrant.

 

(a)                
The Holder hereby acknowledges that: (i) this Warrant and any Warrant Shares purchased pursuant hereto are not being registered
(A) under the Securities Act of 1933 (the “Act”) on the ground that the issuance of this Warrant is exempt
from registration under Section 4(a)(2) of the Act as not involving any public offering, or (B) under any applicable state securities
law because the issuance of this Warrant does not involve any public offering; and (ii) that the Company’s reliance on the
registration exemption under Section 4(a)(2) of the Act and under applicable state securities laws is predicated in part on the
representations hereby made to the Company by the Holder. The Holder represents and warrants that he, she or it is acquiring this
Warrant and will acquire Warrant Shares for investment for his, her or its own account, with no present intention of dividing his,
her or its participation with others or reselling or otherwise distributing this Warrant or Warrant Shares.

 

(b)                
The Holder hereby agrees that he, she or it will not sell, transfer, pledge or otherwise dispose of (collectively, “Transfer”)
all or any part of this Warrant and/or Warrant Shares unless and until he, she or it shall have first obtained an opinion, reasonably
satisfactory to counsel for the Company, of counsel (competent in securities matters, selected by the Holder and reasonably satisfactory
to the Company) to the effect that the proposed Transfer may be made without registration under the Act and without registration
or qualification under any state law.

 

(c)                
If, at the time of issuance of Warrant Shares, no registration statement is in effect with respect to such shares under
applicable provisions of the Act and the Warrant Shares may not be sold pursuant to Rule 144 of the Act, the Company may, at its
election, require that any stock certificate evidencing Warrant Shares shall bear legends reading substantially as follows:

 

“THE SALE, TRANSFER, PLEDGE OR
OTHER DISPOSITION OF THE SHARES REPRESENTED BY THIS CERTIFICATE IS SUBJECT TO CERTAIN RESTRICTIONS SET FORTH IN THE WARRANT PURSUANT
TO WHICH THESE SHARES WERE PURCHASED FROM THE COMPANY. COPIES OF SUCH RESTRICTIONS ARE ON FILE AT THE PRINCIPAL OFFICES OF THE
COMPANY. NO TRANSFER OF SUCH SHARES OR OF THIS CERTIFICATE (OR OF ANY SHARES OR OTHER SECURITIES (OR CERTIFICATES THEREFOR) ISSUED
IN EXCHANGE FOR OR IN RESPECT OF SUCH SHARES) SHALL BE EFFECTIVE UNLESS AND UNTIL THE TERMS AND CONDITIONS SET FORTH IN THE WARRANT
HAVE BEEN COMPLIED WITH.”

 

“THE SHARES REPRESENTED BY THIS
CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AND MAY NOT BE SOLD, TRANSFERRED, PLEDGED OR OTHERWISE DISPOSED
OF IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933 (THE “ACT”) OR AN OPINION
OF COUNSEL SATISFACTORY TO THE ISSUER OF THIS CERTIFICATE THAT REGISTRATION IS NOT REQUIRED UNDER THE ACT.”

 

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In addition, so long as the foregoing legend
may remain on any stock certificate evidencing Warrant Shares, the Company may maintain appropriate “stop transfer”
orders with respect to such certificates and the shares represented thereby on its books and records and with those to whom it
may delegate registrar and transfer functions.

 

3.             Reservation
of Shares. The Company hereby agrees that at all times there shall be reserved for issuance upon the exercise of this
Warrant such number of shares of the Common Stock as shall be required for issuance upon exercise of this Warrant. The Company
further agrees that all Warrant Shares will be duly authorized and will, upon issuance and payment of the exercise price therefor,
be validly issued, fully paid and non-assessable, free from all taxes, liens, charges and encumbrances with respect to the issuance
thereof, other than taxes, if any, in respect of any transfer occurring contemporaneously with such issuance and other than transfer
restrictions imposed by federal and state securities laws.

 

Except and to the extent
as waived or consented to in writing by the Holder, the Company shall not by any action, including, without limitation, amending
its certificate or articles of incorporation or through any reorganization, transfer of assets, consolidation, merger, dissolution,
issue or sale of securities or any other voluntary action, avoid or seek to avoid the observance or performance of any of the terms
of this Warrant, but will at all times in good faith assist in the carrying out of all such terms and in the taking of all such
actions as may be necessary or appropriate to protect the rights of Holder as set forth in this Warrant. Without limiting the generality
of the foregoing, the Company will (a) not increase the par value of any Warrant Shares above the amount payable therefor upon
such exercise immediately prior to such increase in par value, (b) take all such action as may be necessary or appropriate in order
that the Company may validly and legally issue fully paid and nonassessable Warrant Shares upon the exercise of this Warrant, and
(c) use commercially reasonable efforts to obtain all such authorizations, exemptions or consents from any public regulatory body
having jurisdiction thereof as may be necessary to enable the Company to perform its obligations under this Warrant.

 

Before taking any action
which would result in an adjustment in the number of Warrant Shares for which this Warrant is exercisable or in the Exercise Price,
the Company shall obtain all such authorizations or exemptions thereof, or consents thereto, as may be necessary from any public
regulatory body or bodies having jurisdiction thereof.

 

4.             Exchange,
Transfer or Assignment of Warrant. Subject to Section 2, this Warrant is exchangeable, without expense, at the option
of the Holder, upon presentation and surrender hereof to the Company or at the office of its stock transfer agent, if any, for
other Warrants of the Company (“Warrants”) of different denominations, entitling the Holder or Holders
thereof to purchase in the aggregate the same number of Warrant Shares purchasable hereunder. Subject to Section 2, upon surrender
of this Warrant to the Company or at the office of its stock transfer agent, if any, with the Assignment Form attached hereto
as Exhibit B (the “Assignment Form”) duly executed and funds sufficient to pay any transfer tax,
the Company shall, without charge, execute and deliver a new Warrant in the name of the assignee named in the Assignment Form
and this Warrant shall promptly be canceled. Subject to Section 2, this Warrant may be divided or combined with other Warrants
that carry the same rights upon presentation hereof at the office of the Company or at the office of its stock transfer agent,
if any, together with a written notice specifying the names and denominations in which new Warrants are to be issued and signed
by the Holder hereof.

 

5.             Capital
Adjustments. This Warrant is subject to the following further provisions:

 

(a)                
Recapitalization, Reclassification and Succession. If any recapitalization of the Company or reclassification of
its Common Stock or any merger or consolidation of the Company into or with a corporation or other business entity, or the sale
or transfer of all or substantially all of the Company’s assets or of any successor corporation’s assets to any other
corporation or business entity (any such corporation or other business entity being included within the meaning of the term “successor
corporation”) shall be effected, at any time while this Warrant remains outstanding and unexpired, then, as a condition of
such recapitalization, reclassification, merger, consolidation, sale or transfer, lawful and adequate provision shall be made whereby
the Holder of this Warrant thereafter shall have the right to receive upon the exercise hereof as provided in Section 1 and in
lieu of the Warrant Shares immediately theretofore issuable upon the exercise of this Warrant, such shares of capital stock, securities
or other property as may be issued or payable with respect to or in exchange for the number of outstanding shares of Common Stock
equal to the number of Warrant Shares immediately theretofore issuable upon the exercise of this Warrant had such recapitalization,
reclassification, merger, consolidation, sale or transfer not taken place, and in each such case, the terms of this Warrant shall
be applicable to the shares of stock or other securities or property receivable upon the exercise of this Warrant after such consummation.

 

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(b)                
Subdivision or Combination of Shares. If the Company at any time while this Warrant remains outstanding and unexpired
shall subdivide or combine its Common Stock, the number of Warrant Shares purchasable upon exercise of this Warrant shall be proportionately
adjusted.

 

(c)                
Stock Dividends and Distributions. If the Company at any time while this Warrant is outstanding and unexpired shall
issue or pay the holders of its Common Stock, or take a record of the holders of its Common Stock for the purpose of entitling
them to receive, a dividend payable in, or other distribution of, Common Stock, then the number of Warrant Shares purchasable upon
exercise of this Warrant shall be adjusted to the number of shares of Common Stock that Holder would have owned immediately following
such action had this Warrant been exercised immediately prior thereto.

 

(d)                
Price Adjustments. Whenever the number of Warrant Shares purchasable upon exercise of this Warrant is adjusted pursuant
to Sections 5(a), 5(b) or 5(c), the then applicable Warrant Price shall be proportionately adjusted.

 

(e)                
Certain Shares Excluded. The number of shares of Common Stock outstanding at any given time for purposes of the adjustments
set forth in this Section 5 shall exclude any shares then directly or indirectly held in the treasury of the Company.

 

(f)                 
Deferral and Cumulation of De Minimis Adjustments. The Company shall not be required to make any adjustment pursuant
to this Section 5 if the amount of such adjustment would be less than one percent (1%) of the Warrant Price in effect immediately
before the event that would otherwise have given rise to such adjustment. In such case, however, any adjustment that would otherwise
have been required to be made shall be made at the time of and together with the next subsequent adjustment which, together with
any adjustment or adjustments so carried forward, shall amount to not less than one percent (1%) of the Warrant Price in effect
immediately before the event giving rise to such next subsequent adjustment. All calculations under this Section 5 shall be made
to the nearest cent or to the nearest one-hundredth of a share, as the case may be, but in no event shall the Company be obligated
to issue fractional Warrant Shares or fractional portions of any securities upon the exercise of the Warrant.

 

(g)                
Duration of Adjustment. Following each computation or readjustment as provided in this Section 5, the new adjusted
Warrant Price and number of Warrant Shares purchasable upon exercise of this Warrant shall remain in effect until a further computation
or readjustment thereof is required.

 

6.             Notice to Holders.

 

(a)                
Notice of Record Date. In case:

 

(i)                  
the Company shall take a record of the holders of its Common Stock (or other stock or securities at the time receivable
upon the exercise of this Warrant) for the purpose of entitling them to receive any dividend (other than a cash dividend payable
out of earned surplus of the Company) or other distribution, or any right to subscribe for or purchase any shares of stock of any
class or any other securities, or to receive any other right;

 

(ii)                
of any capital reorganization of the Company, any reclassification of the capital stock of the Company, any consolidation
with or merger of the Company into another corporation, or any conveyance of all or substantially all of the assets of the Company
to another corporation; or

 

(iii)               
of any voluntary dissolution, liquidation or winding-up of the Company;

 

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then, and in each such case, the Company
will mail or cause to be mailed to the Holder hereof at the time outstanding a notice specifying, as the case may be, (i) the date
on which a record is to be taken for the purpose of such dividend, distribution or right, and stating the amount and character
of such dividend, distribution or right, or (ii) the date on which such reorganization, reclassification, consolidation, merger,
conveyance, dissolution, liquidation or winding-up is to take place, and the time, if any, is to be fixed, as of which the holders
of record of Common Stock (or such stock or securities at the time receivable upon the exercise of this Warrant) shall be entitled
to exchange their shares of Common Stock (or such other stock or securities) for securities or other property deliverable upon
such reorganization, reclassification, consolidation, merger, conveyance, dissolution or winding-up. Such notice shall be mailed
at least ten (10) calendar days prior to the record date therein specified, or if no record date shall have been specified therein,
at least ten (10) days prior to such specified date.

 

(b)                
Certificate of Adjustment. Whenever any adjustment shall be made pursuant to Section 5 hereof, the Company shall
promptly provide the Holder with prompt written notice, signed and certified by its Chairman, Chief Executive Officer, President
or a Vice President, setting forth in reasonable detail the event requiring the adjustment, the amount of the adjustment, the method
by which such adjustment was calculated and the Warrant Price and number of Warrant Shares purchasable upon exercise of this Warrant
after giving effect to such adjustment.

 

7.             Loss,
Theft, Destruction or Mutilation. Upon receipt by the Company of evidence satisfactory to it, in the exercise of its reasonable
discretion, of the ownership and the loss, theft, destruction or mutilation of this Warrant and, in the case of loss, theft or
destruction, of indemnity reasonably satisfactory to the Company and, in the case of mutilation, upon surrender and cancellation
thereof, the Company will execute and deliver in lieu thereof, without expense to the Holder, a new Warrant of like tenor dated
the date hereof.

 

8.             Warrant
Holder Not a Stockholder. The Holder of this Warrant, as such, shall not be entitled by reason of this Warrant to any
rights whatsoever as a stockholder of the Company, including but not limited to voting rights. No provision hereof, in the absence
of any affirmative action by Holder to exercise this Warrant to purchase Warrant Shares, and no enumeration herein of the rights
or privileges of Holder, shall give rise to any liability of Holder for the purchase price of any Common Stock or as a stockholder
of the Company, whether such liability is asserted by the Company or by creditors of the Company.

 

9.             Registration
Rights. The Holder shall have the registration rights with respect to its Warrant Shares set forth in that certain Securities
Purchase Agreement, dated as of January 25, 2016, between such purchasers and the Company.

 

10.           Notices.
Any notice provided for in this Warrant must be in writing and must be either personally delivered, mailed by first class
mail (postage prepaid and return receipt requested), or sent by reputable overnight courier service (charges prepaid) to the recipient
at the address below indicated:

 

If to the Company:

 

Intellinetics,
Inc.

2190
Dividend Drive

Columbus, OH 43215

Attention: Mr. Matthew L. Chretien,

President and Chief Executive Officer

  

If to the Holder:

 

To the address of such
Holder set forth on the books and records of the Company.

 

or such other address
or to the attention of such other person as the recipient party shall have specified by prior written notice to the sending party.
Any notice under this Warrant will be deemed to have been given (a) if personally delivered, upon such delivery, (b) if mailed,
five days after deposit in the U.S. mail, or (c) if sent by reputable overnight courier service, one business day after such services
acknowledges receipt of the notice.

 

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11.           Choice
of Law. THIS WARRANT IS ISSUED UNDER AND SHALL FOR ALL PURPOSES BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS
OF THE STATE OF NEVADA, WITHOUT GIVING EFFECT TO ITS CONFLICTS OF LAW RULES.

 

12.           Submission
to Jurisdiction. EACH OF THE HOLDER AND THE COMPANY SUBMITS TO THE JURISDICTION OF ANY STATE OR FEDERAL COURT SITTING
IN THE COUNTY OF NEW YORK, STATE OF NEW YORK, IN ANY ACTION OR PROCEEDING ARISING OUT OF OR RELATING TO THIS WARRANT AND AGREES
THAT ALL CLAIMS IN RESPECT OF THE ACTION OR PROCEEDING MAY BE HEARD AND DETERMINED IN ANY SUCH COURT. EACH OF THE HOLDER AND THE
COMPANY ALSO AGREE NOT TO BRING ANY ACTION OR PROCEEDING ARISING OUT OF OR RELATING TO THIS WARRANT IN ANY OTHER COURT. EACH OF
THE PARTIES WAIVES ANY DEFENSE OF INCONVENIENT FORUM TO THE MAINTENANCE OF ANY ACTION OR PROCEEDING SO BROUGHT AND WAIVES ANY
BOND, SURETY, OR OTHER SECURITY THAT MIGHT BE REQUIRED OF ANY OTHER PARTY WITH RESPECT THERETO.

 

13.           Warrant
Register. The Company shall register this Warrant, upon records to be maintained by the Company for that purpose (the
“Warrant Register”), in the name of the record Holder hereof from time to time. The Company may deem
and treat the registered Holder of this Warrant as the absolute owner hereof for the purpose of any exercise hereof or any distribution
to the Holder, and for all other purposes, absent actual notice to the contrary.

 

14.           Miscellaneous.

 

(a)                
Remedies. Holder, in addition to being entitled to exercise all rights granted by law, including recovery of damages,
will be entitled to specific performance of its rights under this Warrant. The Company agrees that monetary damages would not be
adequate compensation for any loss incurred by reason of a breach by it of the provisions of this Warrant and hereby agrees to
waive and not to assert the defense in any action for specific performance that a remedy at law would be adequate.

 

(b)                
Successors and Assigns. Subject to applicable securities laws, this Warrant and the rights and obligations evidenced
hereby shall inure to the benefit of and be binding upon the successors of the Company and the successors and permitted assigns
of Holder. The provisions of this Warrant are intended to be for the benefit of all Holders from time to time of this Warrant and
shall be enforceable by any such Holder or holder of Warrant Shares.

 

(c)                
Amendment. This Warrant may be modified or amended or the provisions hereof waived with the written consent of the
Company and the Holder.

 

(d)                
Severability. Wherever possible, each provision of this Warrant shall be interpreted in such manner as to be effective
and valid under applicable law, but if any provision of this Warrant shall be prohibited by or invalid under applicable law, such
provision shall be ineffective to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions
or the remaining provisions of this Warrant.

 

 

 

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IN WITNESS WHEREOF,
the Company has duly caused this Warrant to be signed on its behalf, in its corporate name and by a duly authorized officer, as
of this 30th day of November, 2016.

 

	 	INTELLINETICS, INC.
	 	 
	 	 
	 	By:	 
	 	 	Matthew L. Chretien

President and Chief Executive Officer

 

    	9 

     

    

EXHIBIT 10.2

 

EXHIBIT A

 

EXERCISE NOTICE

TO BE EXECUTED BY THE REGISTERED HOLDER
TO EXERCISE THIS

WARRANT TO PURCHASE COMMON STOCK

 

Intellinetics,
Inc.

 

The undersigned holder
hereby exercises the right to purchase _________________ of the shares of Common Stock (“Warrant Shares”)
of Intellinetics, Inc., a Nevada corporation (the “Company”), evidenced by Warrant to Purchase Common
Stock No. _______ (the “Warrant”). Capitalized terms used herein and not otherwise defined shall have
the respective meanings set forth in the Warrant.

 

1.       Form
of Exercise Price. The Holder intends that payment of the Exercise Price shall be made as:

 

	____________	a “Cash Exercise” with respect to _________________ Warrant Shares; and/or
	____________	a “Cashless Exercise” with respect to _______________ Warrant Shares.

2.       Payment
of Exercise Price. In the event that the Holder has elected a Cash Exercise with respect to some or all of the Warrant Shares
to be issued pursuant hereto, the Holder shall pay the exercise price in the sum of $___________________ to the Company in accordance
with the terms of the Warrant.

 

3.       Delivery
of Warrant Shares. The Company shall deliver to Holder, or its designee or agent as specified below, __________ Warrant Shares
in accordance with the terms of the Warrant. Delivery shall be made to Holder, or for its benefit, to the following address:

 

_______________________

_______________________

_______________________

_______________________

 

4.       Fractional
Shares. In lieu of receipt of a fractional share of Common Stock, the undersigned will receive a check representing payment
therefor.

 

Date: _______________ __, ______

 

	 	 	 
	Name of Registered Holder	 
	 	 
	By:	 	 
	 	Name: 	 
	 	Title: 	 

 

    	A-1 

     

    

EXHIBIT 10.2

 

EXHIBIT B

 

ASSIGNMENT
FORM

 

Intellinetics,
Inc.

2190
Dividend Drive

Columbus, OH 43215

Attention: Mr. Matthew L. Chretien,

President and Chief Executive Officer

 

 

FOR VALUE RECEIVED, _______________________
hereby sells, assigns and transfers unto

 

(Please print assignee’s name, address
and Social Security/Tax Identification Number)

 

________________________________________________

 

________________________________________________

 

________________________________________________

 

the right to purchase shares of common
stock, par value $0.001 per share, of Intellinetics, Inc., a Nevada corporation (the “Company”), represented
by this Warrant to the extent of shares as to which such right is exercisable and does hereby irrevocably constitute and appoint
____________________________, Attorney, to transfer the same on the books of the Company with full power of substitution in the
premises.

 

	Dated: 	 	 	 
	 	 	 	PRINT WARRANT HOLDER NAME
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 	
Name: 

Title:
	Witness:	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 
	 	 	 	 

 

    	B-1EXHIBIT 10.3

Joseph D. Spain / Employment Agreement

 

 

EMPLOYMENT
AGREEMENT OF JOSEPH D. SPAIN

 

 

This Agreement is made this 2nd day of December, 2016, the”
Effective Date” between IntellineticsTM Inc. (hereinafter, “Employer”) at 2190 Dividend Drive, in the City
of Columbus, County of Franklin, State of Ohio 43228, and Joseph D. Spain, (hereinafter, “Employee”).

 

Recitals

 

A. Employer is engaged in the development, marketing, sales
and support of software applications. Additionally, Employer develops, sells and supports business automation services and solutions.

 

B. Employee is willing to be employed by Employer, and Employer
is willing to employ Employee, on the terms, covenants, and conditions set forth in this Agreement and Employer’s “Offer
of Employment Letter”, dated December 2, 2016, which is hereby incorporated by reference into this Agreement.

 

In consideration of the mutual covenants and promises of the
parties, Employer and Employee covenant and agree as follows:

 

Section I Nature of Employment

 

Employer does hire and employ Employee as CFO, reporting to
President & CEO. Employee’s responsibilities will include, but not limited to activities set forth in the above referenced
Employee Offer Letter. Employee does accept and agree to such hiring and employment. Employee is subject to the supervision, orders,
advice, and directions of Employer.

 

Section II Manner of Performance of Employee’s Duties

 

Employee agrees to perform, at all times faithfully, industriously,
and to the best of Employee’s ability, experience, and talent, all of the duties that may be required of and from Employee
pursuant to the express and implicit terms of this Agreement, to the reasonable satisfaction of Employer. Such duties shall be
rendered at the corporate office, 2190 Dividend Drive, Columbus, OH 43228 and at such other place or places as Employer shall in
good faith require or as the interests, needs, business, and opportunities of Employer shall require or make advisable. A performance
review may be conducted annually. Employee can invite a performance review at any time.

 

Section III Duration of Employment

 

The term of this Agreement shall be for an indeterminate period
and will commence on 12/2/2016. Either party may terminate this Agreement at any time with or without cause. The parties stipulate
and agree that the Employee is an “At Will” employee under Ohio Law and does not have a contract of employment for
a definite period.

 

Section IV Payment and Reimbursement

 

Employer shall pay Employee, and Employee agrees to
accept from Employer, in full payment for Employee’s services under this agreement, the Base Salary, Commissions
Schedules, Bonuses and Profit Sharing as set forth in the aforementioned Offer of Employment Letter. The Base Salary will be
payable biweekly each month during which this agreement shall be in force. Commissions and Bonuses will be paid in accordance
with the schedule of receipt of Project payments by Employer, as appropriate.

 

 

	Revised: AMC, 10/16	Confidential and Proprietary

    	Page 1 of 5

     

    

EXHIBIT 10.3

Joseph D. Spain / Employment Agreement

 

 

In the event that either party terminates this contract at any
time and for any reason (or without assigning a reason) the Employee shall be paid for all work performed and for accrued unused
annual vacation days. Employer will be paid Commissions and / or Bonuses earned on or before the date of termination in proportion
to the payments received by Employer for such work.

 

Employer further agrees employee profit sharing may become part
of Employee’s compensation at the sole discretion of the Employer. Employer has complete discretion to institute or discontinue
employee profit sharing.

 

Section V Professional Employee
Development-Continuing Education

 

Employer recognizes the mutual benefit for Employer and Employee
of professional employee development. Professional education and/or training therefore may be offered and supported at the discretion
of Employer.

 

Section VI Discontinuance
of Business as Termination of Employment

 

Notwithstanding anything in this Agreement to the contrary,
in the event that Employer shall discontinue operating its business, then this Agreement will terminate as of the last day of the
month in which Employer ceases operations with the same force and effect as if that day were originally set forth as the termination
date of this Agreement.

 

Section VII Devotion by Employee
of Full Time to Business

 

Employee shall devote all Employee’s time, attention,
knowledge, and skill solely and exclusively to the business and interest of Employer and Employer shall be entitled to all of the
benefits, emoluments, profits, intellectual property, business process improvements, software, trade secrets or other benefits
or thing of value arising from or incident to any and all work, services, and advice of Employee, and Employee expressly agrees
that during the term of this Agreement Employee shall have no be interest, directly or indirectly, in any form, fashion or manner,
as an owner, partner, officer, director, stockholder, advisor, employee, consultant or in any other form or capacity, in any other
business similar to employer’s business or any allied trade; provided, however, that nothing shall be deemed to prevent or
limit the right of Employee to invest any of Employee’s funds in the capital stock or other securities of any corporation
whose stock or securities are publicly owned or are regularly traded on any public exchange, nor shall anything be deemed to prevent
Employee from investing or limit Employee’s right to invest his funds in real estate.

 

Section VIII Nondisclosure of Trade Secrets and Proprietary
Information.

 

Employee understands that in the performance of his job duties
with the Employer, he will be exposed to the Employer’s Trade Secrets and Proprietary Information. “Trade Secrets and
Proprietary Information” means information or material that is commercially valuable to Employer and not generally known
in the industry. This includes but is not limited to:

 

(a) any and all versions of the Employer’s proprietary
computer software (including source code and object code), hardware, firmware and documentation;

(b) technical information concerning the Employer’s products
and services, including product data and specifications, diagrams, flow charts, drawings, test results, know-how, processes, inventions,
research projects and product development;

(c) sales information, accounting and unpublished financial
information, business plans, markets and marketing methods, customer lists and customer information, purchasing techniques, supplier
lists and supplier information and advertising strategies;

(d) information concerning the Employer’s employees, including
their salaries, strength, weaknesses and skills;

 

 

	Revised: AMC, 10/16	Confidential and Proprietary

    	Page 2 of 5

     

    

EXHIBIT 10.3

Joseph D. Spain / Employment Agreement

 

 

(e) information submitted by or about Employer’s projects,
teaming partners, customers, suppliers, employees, consultants or co-venturers; and

(f) any other information not generally known to the public
which, if misused or disclosed, could reasonably be expected to adversely affect the Employer’s business.

 

Employee will keep the employer’s Trade Secrets and Proprietary
Information, whether or not prepared or developed by employee, in the strictest confidence. Employee will exercise due care to
protect and maintain the confidentiality of Employer’s trade secrets during the term of this contract and for a period of
Five (5) years after the termination of this contract. It is also understood by Employee that access and use of Company Intellectual
Property, Trade Secrets and Proprietary Information does not confer any ownership rights to Employee as all ownership rights shall
be retained by Company. Also, Employee will not use or disclose such secrets to any other person without the Employer’s
written consent, except when necessary to perform employee’s duties. Any breach of the terms of this paragraph is a material
breach of this agreement. However, Employee shall have no obligation to treat as confidential information which:

 

(a) was in Employee’s possession or known to Employee,
without an obligation to keep it confidential, before such information was disclosed to Employee by the Employer;

(b) is or becomes public knowledge through a source other than
Employee and through no fault of Employee; or

(c) is or becomes lawfully available to Employee from a source
other than the Employer.

 

Section IX Corporate Ownership
of Intellectual Property

 

Access and/or use by employee do not confer and any ownership
rights to same. All ownership rights hall be remain the property of the corporation. All work products created by employee associated
with corporate activities shall be owned by employer, including by way of example marketing and/or sales material, messaging, and
presentations.

  

Section X Return of Materials

 

When Employee’s employment with the Employer ends, for
whatever reason, Employee will promptly (within five calendar days) deliver to the Employer all originals and copies of all documents,
records, electronically stored information, software programs, media and other materials received through his employment with Employer.
Employee will also return to Employer all equipment, files, software programs and other property belonging to Employer.

 

Section XI Confidentiality
Obligation Survives Employment

 

Employee understands that Employee’s obligation to maintain
the confidentiality and security of Employer’s Trade Secrets and Proprietary / Legal Information remains with Employee even
after Employment with Employer ends.

 

Section XII Nonsolicitation
of Customers / Clients / Employees

 

Employee covenants and agrees that all times while employed
by Employer and for a further period of two (2) years after the termination of this Agreement, irrespective of when and in what
manner said Agreement may be terminated, Employee will not for himself or any other person or entity, directly or indirectly, by
stock or other ownership, investment, management, consultation, employment or otherwise, or in any relation whatsoever in any manner
solicit, interfere or endanger relationships between Employer and its customers / clients / employees. Employee acknowledges
that failure to comply with provisions of the preceding will cause irreparable damage therefore Employer shall be entitled to an
injunction prohibiting such activities on the part of Employee and all persons acting in concert with Employee.

 

 

	Revised: AMC, 10/16	Confidential and Proprietary

    	Page 3 of 5

     

    

EXHIBIT 10.3

Joseph D. Spain / Employment Agreement

 

 

Section XIII Noncompetition

 

Employee shall not engage in any employment or business activity
anywhere in the United States that directly competes with that of Employer for a period of six (6) months after termination of
Employee’s employment with Employer.

 

Section XIV Commitments Binding
on Employer Only on Written Consent

 

Anything contained in this Agreement to the contrary notwithstanding,
it is understood and agreed that Employee shall not have the right to make any contracts or commitments for or on behalf of Employer
without the written consent of Employer.

 

Section XV Contract Terms
to Be Exclusive

 

This written Agreement and the Offer incorporated herein contain
the sole and entire Agreement between the parties and shall supersede any and all other agreements between the parties. The parties
acknowledge and agree that neither of them has made any representation with respect to the subject matter of this Agreement or
any representations inducing its execution and delivery except such representations as are specifically set forth in this writing
and the parties acknowledge that they have relied on their own judgment in entering into the same. The parties further acknowledge
that any statements or representations that may have been made by either of them to the other are void and of no effect and that
neither of them has relied on such statements or representation in connection with its dealings with the other.

 

Section XVI Waiver or Modification
Ineffective Unless in Writing

 

It is agreed that no waiver or modification of this Agreement
or of any covenant, condition, or limitation contained in it shall be valid unless it is in writing and duly executed by the party
to be charged with it, and that no evidence of any waiver or modification shall be offered or received in evidence in any proceeding,
arbitration, or litigation between the parties arising out of or affecting this Agreement, or the rights or obligations of any
party under it, unless such waiver or modification is in writing, duly executed as above. The parties agree that the provisions
of this paragraph may not be waived except by a duly executed writing.

 

Section XVII Contract Governed
by Law of State of Ohio

 

The parties agree that it is their intention and covenant that
this agreement and performance under it and all suits and special proceedings relating to it be construed in accordance with and
under and pursuant to the laws of the State of Ohio and that in any action, special proceeding, or other proceeding that may be
brought arising out of, in connection with, or by reason of this agreement, the laws of the State of Ohio, exclusive of the choice
of laws rules, shall be applicable and shall govern to the exclusion of the law of any other forum, without regard to the jurisdiction
on which any action or special proceeding may be instituted.

 

Section XVIII Survivorship
of Benefits

 

This Agreement shall be binding on and inure to the benefit
of the respective parties and their executors, administrators, heirs, personal representatives, successors and assigns.

 

 

	Revised: AMC, 10/16	Confidential and Proprietary

    	Page 4 of 5

     

    

EXHIBIT 10.3

Joseph D. Spain / Employment Agreement

 

 

Section XIX Execution of Documents

 

Both while employed by the Employer and for a reasonable time
afterwards, Employee agrees to execute and aid in the preparation of any papers that Employer may consider necessary or helpful
to obtain or maintain any patents, copyrights, trademarks or other proprietary rights at no charge to Employee, but at Employer’s
expense. Employee agrees that any intellectual property, business process, technique or improvement that employee develops, creates
or contributes toward creating during the time that Employee is employed shall be and remain the property of the Employer. Employee
shall execute such assignments or other documents that are helpful or necessary to vest ownership of any and all such property
in the Employer.

 

Employee acknowledges that failure to comply with provisions
of the preceding will cause irreparable damage therefore Employer entitled to an injunction prohibiting such activities on the
part of Employee and all persons acting in concert with Employee.

 

 

Section XX Enforcement

 

Employee agrees that in the event of a breach or threatened
breach of this Agreement, money damages would be an inadequate remedy and extremely difficult to measure. Employee agrees, therefore,
that the Employer shall be entitled to an injunction to restrain Employee form such breach or threatened breach. Nothing in this
Agreement shall be construed as preventing the Employer from pursuing any remedy at law or in equity for any breach or threatened
breach.

 

Section XXI Severability

 

If any provision of this Agreement is determined to be invalid
or unenforceable, the remainder shall be unaffected and shall be enforceable against both the Employer and Employee.

 

 

IN WITNESS WHEREOF, the parties have executed this Agreement
on the dates set forth below.

 

 

 

	IntellineticsTM Inc., Inc.:  	 	Joseph D. Spain	 
	 	 	 	 
	/s/ Matthew L. Chretien	 	/s/ Joseph D. Spain	 
	Matthew L. Chretien, President & CEO	 	Joseph D. Spain	 

 

 

	Date: 12/2/2016            	 	Date: 12/2/2016

 

 

	Revised: AMC, 10/16	Confidential and Proprietary

    	Page 5 of 5

     

    

EXHIBIT 10.3

Joseph D. Spain /OFFER OF EMPLOYMENT

 

 

OFFER OF EMPLOYMENT TO Joseph D. Spain
(Employee)

 

This offer is made December 2, 2016 at the City of Columbus,
County of Franklin, State of Ohio, by IntellineticsTM Inc., 2190 Dividend Drive, Columbus, Ohio 43228 to Joseph D. Spain.

 

We are pleased to offer you employment as CFO, start date to
be 12/2/2016

 

		1.	Reporting the President and CEO.

 

		2.	Remuneration may consist of the following components: Salary, Benefits, Profit Sharing and Bonuses:

 

		a.	The position will start at the rate of One Hundred Forty Thousand Dollars ($140,000) per year, payable biweekly during
each month that this agreement shall be in force.

 

		b.	Bonus – At the Board’s discretion, up to 20% of annual salary based upon company performance and individual contributions.

 

		c.	Grant of 100,000 stock options, vesting 25% at the end of every 12-month period, with full grant accelerator if there is a
sale of company prior to full vesting.

 

		d.	Profit sharing and bonuses may become a component of your compensation at the discretion of Employer.

 

		3.	Benefits:

 

		a.	Participation in a 401(k) profit sharing plan subject to plan eligibility requirements

 

		b.	Discretionary Employer contribution to selected Company health care plan. Amount of Employer contribution to be reviewed and
published annually by Intellinetics.

 

		c.	Twenty (20) business days paid vacation per annum with eligibility to commence after 90-day probationary period. Vacation days
to be scheduled at mutually agreed upon times. Vacation is earned and accrued on a monthly basis with a maximum annual carry over
of five (5) unused vacation days. The probationary period has the following exceptions: 4 days either before or after Christmas.

 

		d.	Cell phone expense reimbursed monthly based on current company policy. Employee will be responsible to carry cell phone plan
with enough coverage and minutes to meet Employer’s needs.

 

		e.	Reimbursement of all reasonable, customary and documented business expenses. Mileage for business travel will be reimbursed
at the current company rate.

 

		f.	Four (4) personal days per annum. Personal days accrue monthly calculated on an annual proportional basis; accrued unused personal
days shall not be carried over into the succeeding year.

 

		g.	Use of on premise Exercise Facility upon execution of Liability and Waiver Form.

 

		h.	Paid Company Holidays; schedule published by Employer annually.

 

    Page 1 of 2

     

    

EXHIBIT 10.3

Joseph D. Spain /OFFER OF EMPLOYMENT

 

		i.	Discretionary Intellinetics contribution for Employee professional development and/or continuing education.

 

		j.	Participation in the Company Health Care plan as provided to all eligible employees.

 

		4.	You or Intellinetics may terminate this employment relationship at any time for cause or without cause by giving written notice.
The parties stipulate and agree that Employee is an “At Will” employee under Ohio Law and does not have a contract
of employment for a definite period. The parties further agree that the Employee’s status shall not change except as set
forth in writing signed by both parties to this Offer.

 

		5.	This offer is contingent upon the satisfactory outcome (as determined by Intellinetics) of pre-employment screening activities
(including a background screening, drug test, employment verification, education verification if applicable and reference check).

 

		6.	We reserve the right to withdraw this offer, as well as employment agreement referenced, if any pre-employment screening activities
come back unsatisfactory. There is no implied relationship or employment with Intellinetics until these contingences are met and
does not change the at-will nature of employee.

 

		7.	This Offer of Employment and supporting Employment Agreement, constitutes all of our agreements and understandings regarding
your employment. There are no other oral or written agreements regarding your employment and no one else, except for the President
of the Company, in writing, is authorized to make any other agreements. Ohio law shall govern this Agreement and any employment
relationship that may be formed between the undersigned parties at any time.

 

	IntellineticsTM Inc., Inc.:  	 	Employee: Joseph D.
    Spain	 
	 	 	 	 
	/s/ Matthew L. Chretien	 	/s/ Joseph D. Spain	 
	Matthew L. Chretien, President & CEO	 		 

 

 

	Date: 12/2/2016     	       	Date: 12/2/2016

 

    Page 2 of 2

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