COMMON STOCK $0.001 PAR VALUE

EX-4.16 12 dex416.htm FORM OF STOCK CERTIFICATE Form of Stock Certificate

EXHIBIT 4.16

 

COMMON STOCK    

COMMON STOCK

$0.001 PAR VALUE

 

INCORPORATED UNDER THE LAWS         CUSIP [            ]
OF THE STATE OF DELAWARE         SEE REVERSE FOR CERTAIN DEFINITIONS
     ALLION HEALTH CARE, INC.     

 

THIS CERTIFIES THAT

 

IS THE OWNER OF

 

FULLY PAID AND NONASSESSABLE SHARES OF ALLION HEALTH CARE, INC.

 

transferable on the books of the Corporation by the holder hereof in person or by duly authorized attorney upon surrender of this certificate properly endorsed.

 

This Certificate is not valid until countersigned by the Transfer Agent and Registrar. Witness the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers.

 

Dated:

[CORPORATE SEAL]


SECRETARY

 

CHAIRMAN, CHIEF

EXECUTIVE OFFICER AND PRESIDENT

   BY   

COUNTERSIGNED AND REGISTERED:

 

TRANSFER AGENT AND REGISTRAR

AUTHORIZED SIGNATURE



This Corporation will furnish without charge to each stockholder who so requests a statement of the powers, designations, preferences and relative, participating, optional or other special rights of each class of stock or series thereof and the qualifications, limitations or restrictions of such preferences and/or rights.

 

The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations:

 

TEN COM

 

   as tenants in common    UNIF GIFT MIN ACT—   
   Custodian   

TEN ENT

 

   as tenants by the entireties         (Cust)            (Minor)

JT TEN

 

   as joint tenants with right of survivorship and not as tenants in common              under Uniform Gifts to Minors Act     
                  
                        (State)     
         Additional abbreviations may also be used though not in the above list.     

 

For Value Received,                                                                   hereby sell(s), assign(s) and transfer(s) unto

 

PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE

 


(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, OF ASSIGNEE)

 


 


 

 


  Shares

 

of the capital stock represented by the within Certificate, and do hereby irrevocably constitute and appoint

 

 


  Attorney Attorney

 

to transfer the said stock on the books of the within named Corporation with full power of substitution in the premises.

 

Dated  

 


 


NOTICE:THE SIGNATURE(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER.
Signature(s) Guaranteed

THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 174d–15.

 

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