Specimen Certificate representing shares of common stock of Dermata Therapeutics, Inc

Contract Categories: Business Finance - Stock Agreements
EX-4.1 6 d137089dex41.htm EX-4.1 EX-4.1

Exhibit 4.1

 

NOTICE:

Signature must be guaranteed by a firm which is a member of a registered national stock exchange, or by a bank (other than a savings bank), or a trust company. The following abbreviations, when used in the inscription on the face of this certificate, shall be constructed 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

   

under Uniform Gifts to Minors

 

survivorship and not as tenants in common

   

Acr............................................

    

(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, OR ASSIGNEE)

 

                                                                                                                                                                                                                                                          

 

                                                                                                                                                                                                                                                          

                                                                                                                                                                                                                                               Shares of the capital stock represented by the written 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:    
   
  Signature
   
  Signature (If more than one owner)
NOTICE:   THE SIGNATURE TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER.
AFFIX MEDALLION SIGNATURE GUARANTEE