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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.
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Date_____________________
Acct. No.________________
Cusip No.________________
S/D______________________
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