TheraSense, Inc. Specimen Common Stock Certificate

Summary

This document is a specimen certificate representing shares of common stock in TheraSense, Inc., a Delaware corporation. It certifies that the named holder owns fully paid and non-assessable shares, which are transferable on the corporation's books by the holder or an authorized attorney upon proper endorsement and surrender of the certificate. The certificate outlines procedures for transfer, replacement if lost, and provides information on shareholder rights. It must be countersigned by the transfer agent and registrar to be valid.

EX-4.1 6 dex41.txt SPECIMEN COMMON STOCK CERTIFICATE EXHIBIT 4.1 [TheraSense LOGO] SHARES -------------------- TS NUMBER INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE COMMON STOCK -------------------- SHARES SEE REVERSE FOR CERTAIN DEFINITIONS CUSIP 883381 10 5 This certificate is transferable in The Cities of Chicago, IL and New York, New York THIS CERTIFIES THAT ----------------------------------------- IS THE RECORD HOLDER OF ----------------------------------------- FULLY PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK, $0.001 PAR VALUE PER SHARE, OF THERASENSE, INC. transferable only on the books of the Corporation by the holder hereof in person or by duly authorized Attorney upon surrender of this certificate properly endorsed. This certificate is not valid until countersigned by the Transfer Agent and Registrar. Witness the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers. [CERTIFICATE OF STOCK] Dated: --------------- [SEAL] /s/ KAREN A. DEMPSEY /s/ W. MARK LORTZ - ------------------------ ----------------------- CORPORATE SECRETARY CHAIRMAN, PRESIDENT AND CHIEF EXECUTIVE OFFICER THERASENSE, INC. THE CORPORATION WILL FURNISH WITHOUT CHARGE TO EACH STOCKHOLDER WHO SO REQUESTS THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OR SERIES THEREOF AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND/OR RIGHTS. SUCH REQUEST MUST BE MADE TO THE CORPORATION'S SECRETARY AT THE PRINCIPAL EXECUTIVE OFFICE OF THE CORPORATION. Keep this certificate in a safe place. If it is lost, stolen or destroyed, the Corporation will require a bond of indemnity as a condition to the issuance of a replacement certificate. 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: UNIF GIFT MIN ACT:_______Custodian_______ (Cust) (Minor) under Uniform Gifts to Minors Act______________________________ (State) TEN COM - as tenants in common UNIF TRANS MIN ACT:______Custodian_______ TEN ENT - as tenants by the entireties (Cust) (Minor) JT TEN - as joint tenants with right of survivorship and under Uniform Transfers to Minors not as tenants in common 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 ZIP CODE, OF ASSIGNEE) ________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________________________________Shares 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 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. In presence of __________________________________ __________________________________ 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. ================================================================================