Assignment And Transfer Of Stock Certificate

FOR VALUE RECEIVED, the undersigned hereby sells, assigns and transfers to

_____________________________the following shares of the stock of

_________________________ (the "Corporation") standing in the name of the undersigned on the books of the Corporation and represented by the following Certificate No (s).:

NUMBER OF SHARES CERTIFICATE NO (S).

_________   ____________________

_________   ____________________

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The undersigned hereby and irrevocably constitutes and appoints

________________________________ as his attorney to transfer the said stock on the books of the Corporation with full power of substitution in the premises.

 

Dated this_____ day of_________________, 201(x).

 

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