Form of Conversion Notice for 10.0% Convertible Promissory Note – Midwest Energy Emissions Corp.
This document is a form used by holders of a 10.0% Convertible Promissory Note issued by Midwest Energy Emissions Corp. to convert a specified principal amount of the note into common stock of the company. By submitting this notice, the holder requests that the company issue and deliver the corresponding shares in accordance with the terms of the note. The form requires the holder's name, signature, and the date of conversion.
EXHIBIT 10.23
CONVERSION NOTICE
The undersigned irrevocably exercises the option to convert U.S $_________________ principal amount of the 10.0% Convertible Promissory Note (the “Note”) of Midwest Energy Emissions Corp. (the “Company”) registered in the name of the undersigned into common stock, par value $.001 per share, of the Company in accordance with the terms of the Note and directs that the securities issuable upon conversion be issued and delivered to the undersigned.
| Dated: ________________ |
|
|
|
|
| Print Name of Holder |
| |
|
|
|
|
|
|
|
| Signature and title (if applicable) |
|
