AMENDMENT NUMBER ONE
PROMISSORY NOTE - NON-NEGOTIABLE
THIS AMENDMENT NUMBER ONE TO PROMISSORY NOTE - NON-NEGOTIABLE ,
dated as of August __, 2007, is hereby executed and delivered by Osage Exploration and Development, Inc., a
Delaware corporation (the “ Company ”), and ____________ (“ Borrower ”).
The Company has provided Borrower with a loan (the “ Loan ”) that is evidenced by a
Promissory Note - Non-Negotiable dated December __, 2006 in the original principal amount of $______ (the “
Note ”), and Borrower has utilized the proceeds thereof to purchase certain shares (“ Shares ”) of common
stock from the Company.
The Company required, and Borrower agreed, at the time of the Loan, that the payment
obligations of Borrower under the Note are to be secured by a pledge of the Shares.
NOW, THEREFORE, in consideration of the foregoing recitals, and other good and valuable
consideration, the receipt and adequacy of which are hereby acknowledged, the Company and Borrower agree
The following paragraph is hereby added at the end of the Note to memorialize the agreement
of the parties (to follow paragraph three):
“This note is secured by a pledge of certain shares of common stock issued to the
Borrower represented by certificate no. __ (the “ Certificate ”) which Certificate shall be held
by the Company as security for payment of all amounts due hereunder.”
There are no amendments intended to be made to the Note other than as expressly
stated in Section 1 above and, except as expressly stated in Section 1 above, the Note, and each and
every provision thereof, shall remain in full force and effect.
Borrower shall cause a counterpart original of this Amendment Number One to be
securely attached to the original of the Note.
Borrower acknowledges that, in connection with the preparation of this Amendment
Number One, and all related matters, McConnell, Dunning & Barwick LLP (