Avalon Pharmaceuticals, Inc. Stock Certificate Assignment and Transfer Form

Summary

This document is a stock certificate assignment and transfer form for Avalon Pharmaceuticals, Inc. It allows the holder to sell, assign, and transfer shares of the company's capital stock to another party by providing the assignee's information and obtaining the necessary signatures. The form requires the signature to match the name on the certificate exactly and must be guaranteed by an eligible financial institution. This ensures the proper and secure transfer of stock ownership according to applicable laws and regulations.

EX-4.1 3 w07623a4exv4w1.htm EXHIBIT 4.1 exv4w1

EXHIBIT 4.1

Avalon Pharmaceuticals, Inc.

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
TEN ENT	—	as tenants by the entireties
JT TEN	—	as joint tenants with right of survivorship and not as tenants in common


UNIF GIFT MIN ACT —		Custodian

	(Cust.)		(Minor)

	under Uniform Gifts to Minors Act.


	(State)

Additional abbreviations may also be used though not in the above list.


For value received,				hereby sell, assign and transfer 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

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 TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THE CERTIFICATION IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER.


SIGNATURE(S) GUARANTEED:

		THE SIGNATURE(S) SHOULD 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 17Ad-15.