Specimen Certificate For Shares of Common Stock

EX-4.1 6 c01111a4exv4w1.htm SPECIMEN CERTIFICATE FOR SHARES OF COMMON STOCK exv4w1
 

Restore Medical
INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE
See reverse side for definitions
CUSIP 76128C 10 0
THIS CERTIFIES THAT
is the owner of
FULLY PAID AND NON-ASSESSABLE COMMON SHARES, $0.01 PAR VALUE, OF
RESTORE MEDICAL, INC.
transferable on the book of the corporation by the holder hereof in person or by attorney upon surrender of this certificate properly endorsed.
This certificate is not valid unless countersigned by the transfer agent and registrar
IN WITNESS WHEREOF, the said corporation has caused this certificate to be signed by facsimile signatures of its duly authorized officers.
Dated: Secretary Chief Executive Officer
countersigned and registered: Wells Fargo Bank, N.A. by
TRANSFER AGENT AND REGISTRAR
AUTHORIZED SIGNATURE

 

 

THE BOARD OF THIS CORPORATION HAS THE AUTHORITY TO CREATE AND DETERMINE THE RELATIVE RIGHTS AND PREFERENCES OF CLASSES OR SERIES OF SHARES OF CAPITAL STOCK OTHER THAN COMMON STOCK. THIS CORPORATION WILL FURNISH TO ANY SHAREHOLDER UPON WRITTEN REQUEST SENT TO ITS PRINCIPAL EXECUTIVE OFFICES, AND WITHOUT CHARGE, A FULL STATEMENT OF THE BOARD’S AUTHORITY TO CREATE AND DETERMINE THE RELATIVE RIGHTS AND PREFERENCES OF CLASSES OR SERIES OF SHARES OF CAPITAL STOCK AS WELL AS THE DESIGNATIONS, PREFERENCES, LIMITATIONS AND RELATIVE RIGHTS OF THE SHARES OF EACH CLASS OR SERIES THEN OUTSTANDING OR AUTHORIZED TO BE ISSUED.
 
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 entireties
 
        
JT TEN
  -   as joint tenants with right of survivorship
and not as tenants in common
             
UTMA -       Custodian    
             
    (Cust)       (Minor)
    under Uniform Transfer 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 POSTAL 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
                      
X  
 
X  
 
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 GUARANTEED
 
ALL GUARANTEES MUST BE MADE BY A FINANCIAL INSTITUTION (SUCH AS A BANK OR BROKER) WHICH IS A PARTICIPANT IN THE SECURITIES TRANSFER AGENTS MEDALLION PROGRAM (“STAMP”), THE NEW YORK STOCK EXCHANGE, INC. MEDALLION SIGNATURE PROGRAM (“MSP”), OR THE STOCK EXCHANGES MEDALLION PROGRAM (“SEMP”) AND MUST NOT BE DATED. GUARANTEES BY A NOTARY PUBLIC ARE NOT ACCEPTABLE.