ASSIGNMENT OF STOCK CERTIFICATE
For value received, I, ________(1)______________, of __________(2)___________, assign to ________(3)_______, of ________(4)__________, assignee __(5)__ shares of stock of
__________(6)___________, which shares stand in my name on the books of such corporation and are represented by certificate No. ___(7)___.
I warrant that the assigned certificate is genuine and, to my knowledge, valid, and that I have the legal right to transfer it.
I appoint assignee my attorney in fact to effect a transfer of the assigned shares on the books of _____(8)________ with full power of substitution in the premises.
Dated _________(9)___________, 19__(10)_.
_____________(11)_____________
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