Election to Convert. To: Coeur d'Alene Mines Corporation The undersigned owner of $________ i▇ ▇▇▇▇▇▇▇▇▇ of Coeur d'Alene Mines Corporation's 9.0% Convertible Senior Subordinated Notes d▇▇ ▇▇▇▇▇▇▇▇ 26, 2007 (the "Convertible Note") hereby irrevocably exercises the option to convert the Convertible Note, or the portion below designated, into Common Stock of Coeur d'Alene Mines Corporation in accordance with the terms of the Indenture ▇▇▇▇▇▇▇▇ ▇▇ in the Convertible Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Date: Amount of Convertible Note to be converted ($1,000 or integral multiples thereof); $______________________________ Signature (for conversion only) _______________________________ Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number: _______________________________ _______________________________ _______________________________ __________________
Appears in 1 contract
Sources: First Supplemental Indenture (Coeur D Alene Mines Corp)
Election to Convert. To: Coeur d'Alene Mines d'▇▇▇▇▇ ▇▇▇▇▇ Corporation The undersigned owner of $________ i▇ in principal of Coeur d'▇▇▇▇▇▇▇▇▇ of Coeur d'Alene Mines Corporation's 9.0% Convertible Senior Subordinated Notes d▇▇ ▇▇▇▇▇▇▇▇ 26Corporation's 13 3/8% Convertible Senior Subordinated Notes due December 31, 2007 2003 (the "Convertible Note") hereby irrevocably exercises the option to convert the Convertible Note, or the portion below designated, into Common Stock of Coeur d'Alene Mines d'▇▇▇▇▇ ▇▇▇▇▇ Corporation in accordance with the terms of the Indenture ▇▇▇▇▇▇▇▇ ▇▇ referred to in the Convertible Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Date: Amount of Convertible Note to be converted ($1,000 or integral multiples thereof); $______________________________ Signature (for conversion only) _______________________________ Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number: _____________________________________ _____________________________________ _____________________________________ _____________________________________ Signature Guarantee(2)
Appears in 1 contract
Sources: Indenture (Coeur D Alene Mines Corp)
Election to Convert. To: Coeur d'Alene Mines Corporation The undersigned owner of $________ i▇ ▇▇▇▇▇▇▇▇▇ of Coeur d'Alene Mines Corporation's 9.0% Convertible Senior Subordinated Notes dNote▇ ▇▇▇ ▇▇▇▇▇▇▇▇ ary 26, 2007 (the "Convertible Note") hereby irrevocably exercises the option to convert the Convertible Note, or the portion below designated, into Common Stock of Coeur d'Alene Mines Corporation in accordance with the terms of the Indenture Indentu▇▇ ▇▇▇▇▇▇▇▇ ▇▇ to in the Convertible Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Date: Amount of Convertible Note to be converted ($1,000 or integral multiples thereof); $______________________________ $ ------------------------ Signature (for conversion only) _______________________________ ----------------------------------------- Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number: _______________________________ _______________________________ _______________________________ __________________----------------------------------------- ----------------------------------------- ----------------------------------------- ----------------------------------------- Signature Guarantee(2)
Appears in 1 contract
Sources: Indenture (Coeur D Alene Mines Corp)