| | Assignment And Transfer Of Stock Certificate
[Date]
[Address]
FOR VALUE RECEIVED, the undersigned hereby sells, assigns
and transfers to [Name of Recipient], [#] shares of the stock of
[Name of Corporation] standing in the name of the undersigned on
the books of the Corporation and represented by Certificate No. [#].
The undersigned hereby and irrevocably constitutes and appoints
[Name of Transfer Agent], attorney-in-fact, to transfer the said stock on
the books of the within named Corporation with full power of
substitution on the premises.
Signed under seal this [date] day of [month, year].
________________________________________
(clearly print name after signature)
Dated:
Witness: ______________________________
[clearly print name after signature]
Sworn and subscribed before me this [numerical] day of [Month],
[Year] A.D.
Notary Public: ______________________________
[clearly print name after signature]
My Commission expires: [Date] |
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