FX Energy, Inc. 2003 Series Convertible Preferred Stock Certificate (Specimen)

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Summary

This document is a specimen stock certificate for FX Energy, Inc.'s 2003 Series Convertible Preferred Stock, issued under Nevada law. It certifies ownership of a specified number of preferred shares, which are fully paid and nonassessable. The certificate outlines restrictions on transfer, requiring compliance with federal and state securities laws. It includes forms for assignment and conversion, allowing holders to transfer shares or convert them into common stock, subject to certain conditions. The certificate also references the rights and preferences of the preferred stock, which are available upon request from the company.

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EX-4.05 4 ex405k123102.txt SPECIMEN STOCK CERTIFICATE Exhibit 4.05
INCORPORATED UNDER THE LAWS OF THE NUMBER STATE OF NEVADA SHARES [number] [shares] FX ENERGY, INC. 2,250,000 AUTHORIZED SHARES OF 2003 SERIES CONVERTIBLE PREFERRED STOCK PAR VALUE $0.001 The securities represented by this certificate have not been registered under the Securities Act of 1933, as amended (the "Securities Act"), or under the securities laws of any state. These securities are "restricted securities" within the meaning of Rule 144 promulgated under the Securities Act. The securities have been acquired for investment and may not be sold or transferred without complying with Rule 144 in the absence of an effective registration or an available exemption from registration under the Securities Act and applicable state statutes. THIS CERTIFIES THAT [name] is the owner of [shares] Shares of fully paid and nonassessable 2003 Series Convertible Preferred Stock, par value $0.001 per share, of FX ENERGY, INC. Transfer of these shares will be registered on the books of the Corporation maintained for that purpose upon presentation of this certificate appropriately endorsed. The 2003 Series Convertible Preferred Stock represented by this certificate has been designated with certain rights, privileges, preferences, and limitations, a full statement of which has been filed in the office of the Secretary of State of the State of Nevada. The holder may obtain from the Corporation, on request and without charge, a copy of a statement setting forth in full the designation of rights, privileges, preferences, and limitations of the 2003 Series Convertible Preferred Stock. IN WITNESS WHEREOF, the duly authorized officers of this Corporation have hereunto subscribed their names and caused the corporate seal to be hereto affixed at Salt Lake City, Utah, this _____ day of ______________________, 2003, A.D. FX ENERGY, INC. By: _____________________________________________ By: ___________________________________ David N. Pierce, President Scott J. Duncan, Secretary FORM OF ASSIGNMENT (Form of assignment to be executed if holder desires to transfer Share Certificate) FOR VALUE RECEIVED, ________________________ hereby sells, assigns, and transfers unto _________________________ the within Share Certificate for _______________ shares of 2003 Series Convertible Preferred Stock, par value $0.001 per share, of FX Energy, Inc., to which the within Share Certificate relates and appoints __________________________________________ attorney to transfer such right on the books of the Company with full power of substitution in the premises. Dated:______________________ _______________________________________________________________ _________________________________ Signature (Signature(s) Must Conform in all Respects to Name(s) (Signature Guaranteed) of Holder(s) as Specified on the Face of the Share Certificate) FORM OF CONVERSION (Form of conversion to be executed by the holder at the time of conversion. The right to convert may be limited in certain circumstances described in the Designation.) The undersigned, the Holder of the within Share Certificate, hereby exercises the right to convert _______________ shares of 2003 Series Convertible Preferred Stock, par value $0.001 per share, of FX Energy, Inc., into shares of common stock, par value U.S. $0.001 per share, of FX Energy, Inc. Please issue the certificate for shares of common stock in the name of: ________________________________________________________ _________________________________________________________ Print or Type Name Social Security or Other Identifying Number ________________________________________________________ _________________________________________________________ Street Address City State Zip Code and, if said number of shares shall not be all the shares represented by the within Share Certificate, please issue a new Share Certificate for the balance of the shares to: ________________________________________________________ _________________________________________________________ Print or Type Name Social Security or Other Identifying Number ________________________________________________________ _________________________________________________________ Street Address City State Zip Code Dated:______________________ _______________________________________________________________ _________________________________ Signature (Signature(s) Must Conform in all Respects to Name(s) (Signature Guaranteed) of Holder(s) as Specified on the Face of the Share Certificate)