GREAT BASIN SCIENTIFIC, INC. INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE COMMON STOCK

Contract Categories: Business Finance - Stock Agreements
EX-4.1 5 d743405dex41.htm EX-4.1 EX-4.1

Exhibit 4.1

 

NUMBER

 

         

SHARES

 

 

GREAT BASIN SCIENTIFIC, INC.

INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE

COMMON STOCK

 

THIS CERTIFIES that     

CUSIP 39013L 106

SEE REVERSE SIDE FOR CERTAIN

DEFINITIONS

is the owner of

FULLY PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK, PAR VALUE $0.001 PER SHARE OF

GREAT BASIN SCIENTIFIC, INC.

transferable only on the books of the Corporation by the holder hereof in person or by Attorney upon surrender of this Certificate properly endorsed. This Certificate is not valid until countersigned by the Transfer Agent and registered by the Registrar.

IN WITNESS WHEREOF, the said Corporation has caused this Certificate to be signed by the facsimile signatures of its duly authorized officers and its Corporate seal to be hereunto affixed.

DATED:

 

 /s/ Ryan Ashton

Secretary

     

 /s/ Ryan Ashton

President

COUNTERSIGNED AND REGISTERED

  AMERICAN STOCK TRANSFER & TRUST COMPANY, LLC

  TRANSFER AGENT AND REGISTRAR

BY

 

 

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,                                                       do hereby sell, assign and transfer unto

 

PLEASE INSERT SOCIAL SECURITY OR OTHER

IDENTIFYING NUMBER OF ASSIGNEE

      

 

      

 

  

 

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

 

 

                                                                                               Shares of the Common Stock represented by the within Certificate, and do hereby irrevocably constitute and appoint                                                                                   Attorney to transfer the said Shares on the books of the within named Corporation with full power of substitution in the premises.

Dated:                                                  

 

  X   
    

 

  X   
    

 

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

Signature(s) Guaranteed

 

By:    
 

 

  
  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.