Document:

Unassociated Document

    Exhibit
      10.2

    

    RURBAN
      FINANCIAL CORP.

    2008
      STOCK INCENTIVE PLAN

    

    RESTRICTED
      STOCK AWARD AGREEMENT

    (For
      Employees)

     

    In
      recognition of your services to Rurban Financial Corp. (the “Company”) and its
      Subsidiaries, the Compensation Committee of the Board of Directors of the
      Company has granted to you restricted common shares, without par value, of
      the
      Company (“Restricted Stock”), subject to the terms and conditions described in
      the Rurban Financial Corp. 2008 Stock Incentive Plan (the “Plan”) and this
      Restricted Stock Award Agreement (this “Award Agreement”).

     

    To
      ensure
      you fully understand the terms and conditions of your Restricted Stock, you
      should read the Plan and this Award Agreement carefully. Capitalized terms
      that
      are not defined in this Award Agreement have the same meanings as in the
      Plan.

     

    You
      should return a signed copy of this Award Agreement to:

     

    Keeta
      J.
      Diller

    Vice
      President and Corporate Secretary

    Rurban
      Financial Corp.

    401
      Clinton Street

    Defiance,
      Ohio 43512

     

    1.    
Summary
      of Your Restricted Stock

     

    Grant
      Date: __________,
      20___

     

    Number
      of Shares of Restricted Stock: ________
      Shares

     

    2.    Transfer
      Restrictions and Restriction Periods

    

    (a)    Transfer
      Restrictions:
      Until
      the Restriction Period (as described below) lapse, your Restricted Stock will
      be
      subject to a risk of forfeiture and the Company will hold it in escrow. Except
      as described below, you may not sell, transfer, pledge, assign, alienate or
      hypothecate your shares of Restricted Stock. After the Restriction Periods
      lapse, your Restricted Stock will be distributed to you or forfeited, depending
      on whether or not you satisfy the terms and conditions described in this Award
      Agreement.

    

    (b)    Restriction
      Periods:

    

    (i)    Subject
      to the provisions of the Plan and this Award Agreement (including Section 3),
      the restrictions on your Restricted Stock will lapse and the Restricted Stock
      will become fully vested on ___________, 20____.

     

    
      
         

      

      
         

        
          

        

      

      
         

      

       

    

    (ii)    Notwithstanding
      the foregoing and unless otherwise specified in a separate change in control
      agreement (or similar written agreement) between you and the Company, the
      Restriction Periods will lapse and the Restricted Stock will become fully vested
      if an Applicable Event occurs.

    

    3.    Effect
      of Retirement or Other Termination on Restricted Stock

    

    (a)    Retirement:
      If you
      voluntarily terminate your service as an Employee and, if applicable, a Director
      after (i) attaining the age of 62 and (ii) completing five years of service
      to
      the Company or any Subsidiary, the Restriction Periods will lapse and the
      Restricted Stock will become fully vested on the date of your
      termination.

    

    (b)    Death
      or Disability: If
      your
      service as an Employee and, if applicable, a Director of the Company terminates
      due to your death or Disability, the Restriction Periods will lapse and the
      Restricted Stock will become fully vested on the date of your termination.
      

    

    (c)    Termination
      for Any Other Reason:
      Except
      as provided in Section 2(b)(ii), if your service as an Employee and, if
      applicable, a Director of the Company terminates for any reason other than
      death, Disability or Retirement, any unvested shares of Restricted Stock will
      be
      forfeited on the date of your termination.

    

    4.    Settling
      Your Restricted Stock

    

    Your
      Restricted Stock will be released from escrow and distributed to you as soon
      as
      practicable after all terms, restrictions and conditions described in the Plan
      and this Award Agreement have been satisfied. Any fractional share of Restricted
      Stock will be forfeited.

    

    5.    Other
      Rules Affecting Your Restricted Stock

    

    (a)    Rights
      During the Restriction Period:
      During
      the Restriction Periods (and even though the shares of Restricted Stock are
      held
      in escrow until they are settled), you (i) may exercise full voting rights
      associated with the shares of Restricted Stock and (ii) will be entitled to
      receive all dividends and other distributions paid with respect to that
      Restricted Stock; provided, however, that if any dividends or other
      distributions are paid in shares of Stock, those shares will be subject to
      the
      same restrictions on transferability and forfeitability as the shares of
      Restricted Stock with respect to which they were issued under this Award
      Agreement.

    

    (b)    Beneficiary
      Designation:
      You may
      name a beneficiary or beneficiaries to receive Restricted Stock that has vested
      but has not been settled at the time of your death by completing and filing
      with
      the Committee a written beneficiary designation on a form prescribed by the
      Committee. If you have not completed a beneficiary designation form or if you
      wish to change your beneficiary, you may complete the beneficiary designation
      form attached to this Award Agreement as Exhibit
      A.
      You do
      not need to designate a beneficiary now and no designation is required to be
      completed as a condition of receiving your Restricted Stock. Upon your death,
      the Company will deliver any shares underlying your Restricted Stock to your
      beneficiary upon receipt by the Company of proof of identity and the existence
      of a validly designated beneficiary at the time of your death. However, if
      you
      die without designating a beneficiary or if you do not complete the form
      correctly, the Company will deliver any shares underlying your Restricted Stock
      to the executor or administrator of your estate, or if no such executor or
      administrator has been appointed to the knowledge of the Company, the Company
      may, in its sole discretion, deliver such Stock to your spouse or to any one
      or
      more of your dependents as the Company may designate. 

    

    
      
         

      

      
        2

        
          

        

      

      
         

      

       

    

    (c)    Tax
      Withholding: The
      Company will have the right and is hereby authorized to deduct or withhold
      an
      amount sufficient to satisfy federal, state and local taxes required by law
      to
      be withheld with respect to your Restricted Stock. At the sole discretion of
      the
      Committee, you may be permitted to satisfy the foregoing withholding liability
      by paying to the Company the withholding amount in cash, through the delivery
      or
      attestation of shares of Stock you have owned for at least the previous six
      months (or such other period acceptable under generally accepted accounting
      principles) with a Fair Market Value equal to the statutory minimum withholding
      liability or by having the Company withhold shares of Stock that would otherwise
      be issued to you when your Restricted Stock is settled with a Fair Market Value
      equal to the statutory minimum withholding liability. 

    

    (d)    Transferring
      Your Restricted Stock: During
      the Restriction Periods, your Restricted Stock may not be sold, transferred,
      pledged, assigned or otherwise alienated or hypothecated, except by will or
      the
      laws of descent and distribution. However, as described in Section 4(b), you
      may
      designate a beneficiary who may receive any Restricted Stock that is settled
      after your death. Also, with the Committee’s consent, you may be allowed to
      transfer your Restricted Stock to an immediate family member, a partnership
      consisting solely of immediate family members or trusts for the benefit of
      immediate family members. Contact us at the address given on the first page
      of
      this Award Agreement if you are interested in transferring your Restricted
      Stock
      to such a transferee.

    

    (e)    Adjustments
      to Your Restricted Stock:
      If there
      is a Stock dividend, Stock split, recapitalization (including payment of an
      extraordinary dividend), merger, consolidation, combination, spin-off,
      distribution of assets to shareholders, exchange of shares or other similar
      corporate change affecting the Stock, the Committee will appropriately adjust
      the number of shares of Restricted Stock and any other factors, limits or terms
      affecting your Restricted Stock. Notwithstanding the foregoing, an adjustment
      will be made only to the extent such adjustment complies with Section 409A
      of
      the Code, to the extent applicable.

    

    (f)    Restrictions
      on Transfer of Stock: Shares
      of
      Stock tendered under this Award Agreement may be subject to any stock transfer
      orders and other restrictions that the Committee believes to be advisable under
      the rules, regulations and other requirements of the Securities and Exchange
      Commission, any exchange, market or other quotation system on or through which
      the Company’s securities are then traded, or any applicable federal or state
      securities law. The Committee may cause a legend or legends to be placed on
      any
      certificates issued under this Award Agreement to make appropriate reference
      to
      any restrictions.

    

    (g)    Tenure:
      Nothing
      in the Plan or this Award Agreement shall confer upon you the right to continue
      as an Employee or Director, as applicable, of the Company or any
      Subsidiary.

     

    (h)    Governing
      Law:
      This
      Award Agreement will be construed in accordance with and governed by the laws
      (other than laws governing conflicts of laws) of the State of Ohio.

    

    
      
         

      

      
        3

        
          

        

      

      
         

      

       

    

    (i)    Amendment
      of Award Agreement:
      This
      Award Agreement may be amended by a written agreement signed by both parties
      to
      this Award Agreement; provided, however, that the Company may amend this Award
      Agreement to the extent necessary to comply with applicable law without your
      consent or any additional consideration, even if those amendments eliminate,
      restrict or reduce your rights under this Award Agreement.

    

    (j)    Other
      Terms and Conditions:
      Your
      Restricted Stock is subject to the terms and conditions described in this Award
      Agreement and the Plan, which is incorporated by reference into and made a
      part
      of this Award Agreement. You should read the Plan carefully to ensure you fully
      understand all the terms and conditions of your Restricted Stock. In the event
      of a conflict between the terms of the Plan and the terms of this Award
      Agreement, the terms of the Plan will govern. The Committee has the sole
      responsibility of interpreting the Plan and this Award Agreement, and its
      determination of the meaning of any provision in the Plan or this Award
      Agreement shall be binding on you.

    

    (k)    Other
      Agreements: Your
      Restricted Stock will be subject to the terms of any other written agreements
      between you and the Company to the extent that those other agreements do not
      directly conflict with the terms of the Plan or this Award
      Agreement.

    

    (l)    Signature
      in Counterparts: This
      Award Agreement may be signed in counterparts, each of which will be deemed
      an
      original, but all of which will constitute one and the same
      instrument.

    

    * * * * *

    

    Your
      Acknowledgement

    

    By
      signing below as the “Participant,” you acknowledge and agree that:

    

    	·  	
            A
              copy of the Plan has been made available to you;
              and

          

    	·  	
            You
              understand and accept the terms and conditions placed on your Restricted
              Stock.

          

     

    
      	PARTICIPANT	 	RURBAN FINANCIAL CORP.	 
	 	 	 	 	 	 
	 	 	 	 	 	 
	 	 	 	 
	Print
              Name:	 	 	Print
              Name:	 	 
	 	 	 	Title:	 	 
	 	 	 	 	 	 

    

    
      	Date:	 	 	Date:	 	 

    

     

    
      
         

      

      
        4Exhibit
      10.1

    STOCK
      OPTION AGREEMENT

    

    LA
      CORTEZ ENERGY, INC.

     

    THIS
      AGREEMENT is entered into as of the ____ day of ____, 200_
      (the
“Date of Grant”)

     

    BETWEEN:

     

    LA
      CORTEZ ENERGY, INC.,
      a
      company incorporated pursuant to the laws of the State of Nevada, 

     

    (the
      “Company”)

     

    AND:

     

    ____________,
      of
      ______________________

     

    (the
      “Optionee”)

     

    WHEREAS:

     

    A.  The
      Board
      of Directors of the Company (the “Board”) has approved and adopted the La Cortez
      Energy, Inc. 2008 Equity Incentive Plan (the “2008 Plan”), pursuant to which the
      Board is authorized to grant to employees and other selected persons stock
      options to purchase common shares of the Company (the “Common
      Stock”);

     

    B.  The
      2008
      Plan provides for the granting of stock options that either (i) are intended
      to
      qualify as “Incentive Stock Options” within the meaning of Section 422 of the
      Internal Revenue Code of 1986, as amended (the “Code”), or (ii) do not qualify
      under Section 422 of the Code (“Non-Qualified Stock Options”); and

     

    C.  The
      Board
      has authorized the grant to Optionee of options to purchase a total of
_____________________________________
      (_______)
      shares
      of Common Stock (the “Options”), which Options are intended to be (select
      one):

     

    [
       ] Incentive
      Stock Options;

    [
      X ] Non
      Qualified Stock Options.

     

    NOW
      THEREFORE, the Company agrees to offer to the Optionee the option to purchase,
      upon the terms and conditions set forth herein and in the Plan, ______________________________________
      (_______)
      shares
      of Common Stock. Capitalized terms not otherwise defined herein shall have
      the
      meanings ascribed thereto in the 2008 Plan.

     

    1.  Exercise
      Price.
      The
      exercise price of the options shall be US$_____
      per
      share.

    

    2.  Limitation
      on the Number of Shares.
      If the
      Options granted hereby are Incentive Stock Options, the number of shares which
      may be acquired upon exercise thereof is subject to the limitations set forth
      in
      Section 6(e)(iv) of the 2008 Plan.

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

     

    3.  Vesting
      Schedule.
      The
      Options shall vest in accordance with Exhibit A.

    

    4.  Options
      not Transferable.
      The
      Options may not be transferred, assigned, pledged or hypothecated in any manner
      (whether by operation of law or otherwise) other than by will, by applicable
      laws of descent and distribution or, in the case of a Non-Qualified Stock
      Option, pursuant to a qualified domestic relations order, and shall not be
      subject to execution, attachment or similar process; provided,
      however,
      that if
      the Options represent a Non-Qualified Stock Option, such Option is transferable
      without payment of consideration to immediate family members of the Optionee
      or
      to trusts or partnerships established exclusively for the benefit of the
      Optionee and Optionee’s immediate family members. Upon any attempt to transfer,
      pledge, hypothecate or otherwise dispose of any Option or of any right or
      privilege conferred by the 2008 Plan contrary to the provisions thereof, or
      upon
      the sale, levy or attachment or similar process upon the rights and privileges
      conferred by the 2008 Plan, such Option shall thereupon terminate and become
      null and void.

    

    5.  Investment
      Intent.
      By
      accepting the Options, the Optionee represents and agrees that none of the
      shares of Common Stock purchased upon exercise of the Options will be
      distributed in violation of applicable federal and state laws and regulations.
      In addition, the Company may require, as a condition of exercising the Options,
      that the Optionee execute an undertaking, in such a form as the Company shall
      reasonably specify, that the Stock is being purchased only for investment and
      without any then-present intention to sell or distribute such
      shares.

    

    6.  Termination
      of Status as a Member of the Board of Directors and Options.
      Vested
      Options shall terminate, to the extent not previously exercised, upon the
      occurrence of the first of the following events:

     

    	(a)  	
            Expiration.
              Ten (10) years from the Date of Grant.

          

     

    	(b)  	
            Termination
              for Cause.
              The date of the first discovery by the Company of any reason for the
              termination of an Optionee’s status as a member of the Board of Directors
              of the Company or any related company for cause (as determined in the
              sole
              discretion of the 2008 Plan administrator), and, if an Optionee’s status
              as a member of the Board of Directors is suspended pending any
              investigation by the Company as to whether the Optionee’s status as a
              member of the Board of Directors should be terminated for cause, the
              Optionee’s rights under this Agreement and the 2008 Plan shall likewise be
              suspended during the period of any such
              investigation.

          

     

    	(c)  	
            Termination
              Due to Death or Disability.
              The expiration of one (1) year from the date of the death of the Optionee
              or cessation of an Optionee’s status as a member of the Board of Directors
              by reason of Disability (within the meaning of Section 22(e) of the
              Code).
              If an Optionee’s status as a member of the Board of Directors is
              terminated by death, any Option held by the Optionee shall be exercisable
              only by the person or persons to whom such Optionee’s rights under such
              Option shall pass by the Optionee’s will or by the laws of descent and
              distribution.

          

     

    
      
         

      

      
        2

        
          

        

      

      
         

      

    

     

    	(d)  	
            Termination
              for Any Other Reason.
              The expiration of three (3) months from the date of an Optionee’s
              termination of status as a member of the Board of Directors of the
              Company
              or any affiliated company or subsidiary of the Company (a “Related
              Corporation”) for any reason whatsoever other than termination of service
              for cause, death or Disability.

          

    

    Each
      unvested Option granted pursuant hereto shall terminate immediately upon
      termination of the Optionee’s status as a member of the Board of Directors of
      the Company for any reason whatsoever, including Disability unless vesting
      is
      accelerated in accordance with Section 11(e) of the 2008 Plan.

     

    7.  Stock.
      In the
      case of any stock split, stock dividend or like change in the nature of shares
      of Stock covered by this Agreement, the number of shares and exercise price
      shall be proportionately adjusted as set forth in Section 5(b) of the 2008
      Plan.

    

    8.  Exercise
      of Option.
      Options
      shall be exercisable, in full or in part, at any time after vesting, until
      termination; provided,
      however,
      that any
      Optionee who is subject to the reporting and liability provisions of Section
      16
      of the Securities
      Exchange Act
      of 1934
      with respect to the Common Stock shall be precluded from selling or transferring
      any Common Stock or other security underlying an Option during the six (6)
      months immediately following the grant of that Option. If less than all of
      the
      shares included in the vested portion of any Option are purchased, the remainder
      may be purchased at any subsequent time prior to the expiration of the Option
      term. No portion of any Option for less than fifty (50) shares (as adjusted
      pursuant to Section 5(b) of the 2008 Plan) may be exercised; provided, that
      if
      the vested portion of any Option is less than fifty (50) shares, it may be
      exercised with respect to all shares for which it is vested. Only whole shares
      may be issued pursuant to an Option, and to the extent that an Option covers
      less than one (1) share, it is unexercisable.

    

    Each
      exercise of the Option shall be by means of delivery of a notice of election
      to
      exercise (which may be in the form attached hereto as Exhibit
      B)
      to the
      President of the Company at its principal executive office, specifying the
      number of shares of Common Stock to be purchased and accompanied by payment
      in
      cash by certified check or cashier’s check in the amount of the full exercise
      price for the Common Stock to be purchased. In addition to payment in cash
      by
      certified check or cashier’s check, an Optionee or transferee of an Option may
      pay for all or any portion of the aggregate exercise price by complying with
      one
      or more of the following alternatives:

     

    	(a)  	
            by
              delivering to the Company shares of Common Stock previously held by
              such
              person, duly endorsed for transfer to the Company, or by the Company
              withholding shares of Common Stock otherwise deliverable pursuant to
              exercise of the Option, which shares of Common Stock received or withheld
              shall have a fair market value at the date of exercise (as determined
              by
              the 2008 Plan administrator) equal to the aggregate purchase price
              to be
              paid by the Optionee upon such exercise;
              or

          

     

    
      
         

      

      
        3

        
          

        

      

      
         

      

    

     

    	(b)  	
            by
              complying with any other payment mechanism approved by the 2008 Plan
              administrator at the time of exercise.

          

    

    It
      is a
      condition precedent to the issuance of shares of Common Stock that the Optionee
      execute and/or deliver to the Company all documents and withholding taxes
      required in accordance with Sections 11(a) and 11(f) of the 2008
      Plan.

     

    9.  Holding
      period for Incentive Stock Options.
      In order
      to obtain the tax treatment provided for Incentive Stock Options by Section
      422
      of the Code, the shares of Common Stock received upon exercising any Incentive
      Stock Options received pursuant to this Agreement must be sold, if at all,
      after
      a date which is later of two (2) years from the date of this agreement is
      entered into or one (1) year from the date upon which the Options are exercised.
      The Optionee agrees to report sales of shares prior to the above determined
      date
      to the Company within one (1) business day after such sale is concluded. The
      Optionee also agrees to pay to the Company, within five (5) business days after
      such sale is concluded, the amount necessary for the Company to satisfy its
      withholding requirement required by the Code in the manner specified in Section
      11(f) of the 2008 Plan. Nothing in this Section 9 is intended as a
      representation that Common Stock may be sold without registration under state
      and federal securities laws or an exemption therefrom or that such registration
      or exemption will be available at any specified time.

    

    10.  Resale
      restrictions may apply.
      Any
      resale of the shares of Common Stock received upon exercising any Options will
      be subject to resale restrictions contained in the securities legislation
      applicable to the Optionee. The Optionee acknowledges and agrees that the
      Optionee is solely responsible (and the Company is not in any way responsible)
      for compliance with applicable resale restrictions.

    

    11.  Subject
      to 2008 Plan.
      The
      terms of the Options are subject to the provisions of the 2008 Plan, as the
      same
      may from time to time be amended, and any inconsistencies between this Agreement
      and the 2008 Plan, as the same may be from time to time amended, shall be
      governed by the provisions of the 2008 Plan, a copy of which has been delivered
      to the Optionee, and which is available for inspection at the principal offices
      of the Company.

    

    12.  Professional
      Advice.
      The
      acceptance of the Options and the sale of Common Stock issued pursuant to the
      exercise of Options may have consequences under federal and state tax and
      securities laws which may vary depending upon the individual circumstances
      of
      the Optionee. Accordingly, the Optionee acknowledges that he or she has been
      advised to consult his or her personal legal and tax advisor in connection
      with
      this Agreement and his or her dealings with respect to Options. Without limiting
      other matters to be considered with the assistance of the Optionee’s
      professional advisors, the Optionee should consider: (a) whether upon the
      exercise of Options, the Optionee will file an election with the Internal
      Revenue Service pursuant to Section 83(b) of the Code and the implications
      of
      alternative minimum tax pursuant to the Code; (b) the merits and risks of an
      investment in the underlying shares of Common Stock; and (c) any resale
      restrictions that might apply under applicable securities laws.

    

    
      
         

      

      
        4

        
          

        

      

      
         

      

    

     

    13.  No
      Employment Relationship.
      Whether
      or not any Options are to be granted under this 2008 Plan shall be exclusively
      within the discretion of the 2008 Plan administrator, and nothing contained
      in
      this 2008 Plan shall be construed as giving any person any right to participate
      under this 2008 Plan. The grant of an Option shall in no way constitute any
      form
      of agreement or understanding binding on the Company or any Related Company,
      express or implied, that the Company or any Related Company will employ or
      contract with an Optionee, for any length of time, nor shall it interfere in
      any
      way with the Company’s or, where applicable, a Related Company’s right to
      terminate Optionee’s employment at any time, which right is hereby
      reserved.

    

    14.  Entire
      Agreement.
      This
      Agreement is the only agreement between the Optionee and the Company with
      respect to the Options, and this Agreement and the 2008 Plan supersede all
      prior
      and contemporaneous oral and written statements and representations and contain
      the entire agreement between the parties with respect to the
      Options.

    

    15.  Notices.
      Any
      notice required or permitted to be made or given hereunder shall be mailed
      or
      delivered personally to the addresses set forth below, or as changed from time
      to time by written notice to the other:

    

    The
      Company:

     

    La
      Cortez
      Energy, Inc.

    1266
      1st
      Street,
      Suite 4

    Sarasota,
      FL 34236

    Attention:
      President

     

    With
      a
      copy to:

     

    Gottbetter
      & Partners, LLP

    488
      Madison Avenue, 12th
      Floor

    New
      York,
      NY 10022

    Attention:
      Adam S. Gottbetter

     

    The
      Optionee:

     

    
      ______________________

      ______________________

      ______________________

      ______________________

    

     

    
      
         

      

      
        5

        
          

        

      

      
         

      

    

    

    
      	LA
              CORTEZ
              ENERGY, INC.	 	 	 
	 	 	 	 	 
	Per:	 	 	 	 
	 	
              
Authorized
              Signatory	 	 	
            
	 	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 
	
              
[Optionee]	 	 	 

    

     

    
      
         

      

      
        6

        
          

        

      

      
         

      

    

    EXHIBIT
      A

     

    TERMS
      OF THE OPTION

     

    
      Name
        of the Optionee:

      
         

        Date
          of Grant:

        
           

          Designation:

           

          
            
              	1.	
                      Number
                        of Options granted:

                    

              	 	 

            

          

          
            
              	
                      2.

                    	
                      Purchase
                        Price:

                    

              	 	 

            

            
              
                	3.	
                        Vesting
                          Dates:

                      

                	 	 

              

              
                
                  	4.	
                          Expiration
                            Date:

                        

                

              

            

          

        

      

    

     

    
      
         

      

      
        7

        
          

        

      

      
         

      

    

     

    EXHIBIT
      B

     

    To:

     

    La
      Cortez
      Energy, Inc.

     

    Attention:
      President

     

    Notice
      of Election to Exercise

     

    This
      Notice of Election to Exercise shall constitute proper notice under the La
      Cortez Energy, Inc.’s (the “Company”) 2008 Equity Incentive Plan (the “2008
      Plan”) pursuant to Section 8 of that certain Stock Option Agreement (the
“Agreement”) dated as of the ___ day of _____, 200_, between the Company and the
      undersigned.

     

    The
      undersigned hereby elects to exercise Optionee’s option to purchase shares
      of
      the common stock of the Company at a price of US$____ per share, for aggregate
      consideration of US$,
      on the
      terms and conditions set forth in the Agreement and the 2008 Plan. Such
      aggregate consideration, in the form specified in Section 8 of the Agreement,
      accompanies this notice.

     

    The
      Optionee hereby directs the Company to issue, register and deliver the
      certificates representing the shares as follows:

     

    
      	
              Registration
                Information:

            	 	
              Delivery
                Instructions:

            
	 	 	 
	
              Name
                to appear on certificates

            	 	
              Name

            
	 	 	 
	
              Address

            	 	
              Address

            
	 	 	 
	 	 	 
	 	 	 
	 	 	
              Telephone
                Number

            

    

    

    DATED
      at
      ____________________________________, the day
      of
      ________________________, 20___.

     

    
      	 	 	 
	 
 	 
 	 
 
	 	 	 
	 	
              
(Name
              of Optionee - Please type or print)
	 	 
	 	 
	 	
              
(Signature
              and, if applicable, Office)
	 	 
	 	 
	 	
              
(Address
              of Optionee)
	 	 
	 	 
	 	
              
(City,
              State, and Zip Code of
              Optionee)

    

     

    
      
         

      

      
        8

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00145-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00145-of-00352.parquet"}]]