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STOCK OR BOND POWER
FOR VALUE RECEIVED, the undersigned does (do) hereby sell, assign
and transfer to:
______________________________________________________________________
______________________________________________________________________
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If Stock, complete this portion
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_______________shares of the _______________stock of
___________ represented by Certificate(s) No(s)
_______________________inclusive, standing in the name of the undersigned
on the books of said Company.
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If Bonds, complete this portion
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_________________________bonds of
__________________________ in the principal amount of $___________,No(s)
_____________inclusive, standing in the name of the undersigned on the
books of said Company.
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The undersigned does(do) hereby irrevocably constitute and
appoint______________ attorney to transfer the said stock or bond(s), as the
case may be, on the books of said Company, with full power of substitution in
the premises.
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______________________________
Signature
______________________________
Print Name as signed above
______________________________
SSN
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_____________________________________
Signature
_____________________________________
Print Name as signed above
_____________________________________
SSN
IMPORTANT-READ CAREFULLY - - The
signature(s) to this Power must correspond with the name(s) as written upon
the face of the certificate(s) or bond(s) in every particular without
alterations or change whatever. Signature(s) must be stamped with a Medallion Signature Guarantee by a qualified financial institution (such as a commercial bank, savings bank, savings and loan, US Stockbroker and security dealer, or credit union) that is participating in an approved Medallion Signature Guarantee Program. A NOTARY SEAL IS NOT ACCEPTABLE.
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Date_____________________
Acct. No.________________
Cusip No.________________
S/D______________________
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