under Uniform Gifts to Minors

EX-4.1 3 d636303dex41.htm EX-4.1 EX-4.1

Exhibit 4.1

 

Dated:
COUNTERSIGNED AND REGISTERED:
AMERICAN STOCK TRANSFER & TRUST COMPANY, LLC
(Brooklyn, NY)
TRANSFER AGENT AND REGISTRAR
BY:
AUTHORIZED SIGNATURE
CUSIP 171604 10 1

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     Act    

 

under Uniform Gifts to Minors

 

          (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 common 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 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 17Ad-15.