CANCELLATION OF INDEBTEDNESS IN EXCHANGE FOR SHARES OF COMMON STOCK The receipt of [N] shares stock of [NAME OF CORPORATION OFFERING SHARES OF STOCK] (“Offeror”) for the cancellation by [NAME OF ENTITY RECEIVING SHARES OF STOCK] (“Recipient”) of a current loan outstanding to Recipient, dated [DATE] with a remaining unpaid principal amount and unpaid accrued interest, if any, totaling $[N] is hereby acknowledged.
For Offeror:
For Recipient:
Print Name and Title
Print Name and Title
Date: August 12, 2008
Date: August 12, 2008