Form of the Registrant's Common Stock Certificate

EX-4.1 4 c11964a2exv4w1.htm FORM OF THE REGISTRANT'S COMMON STOCK CERTIFICATE exv4w1

Exhibit 4.1



NUMBER		SHARES



		INCORPORATED UNDER THE LAWS OF THE STATE		CUSIP ___
		OF WISCONSIN		See Reverse for Certain Definitions

TOMOTHERAPY INCORPORATED

THIS CERTIFIES THAT

is the record holder of

Fully Paid and Non-Assessable Shares of Common Stock,
0.001 Par Value Per Share of
TOMOTHERAPY INCORPORATED


		transferable on the books of the Corporation 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 registered by the Registrar.

[SEAL]		WITNESS the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers.
		Dated:


	COUNTERSIGNED AND REGISTERED:
	WELLS FARGO BANK, N.A.
		TRANSFER AGENT AND REGISTRAR
	By
		AUTHORIZED SIGNATURE
/s/ Shawn D. Guse	/s/ Frederick A. Robertson, M.D.
Secretary	Chief Executive Officer

TOMOTHERAPY INCORPORATED

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 the entireties
JT TEN	—	as joint tenants with right of survivorship and not as tenants in common


UNIF GIFT MIN ACT —		Custodian

	(Cust)		(Minor)
	under Uniform Gifts to Minors Act


	(State)
UNIF TRF MIN ACT —		Custodian (until age ___)

	(Cust)		(Minor)
	under Uniform Transfers 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 ZIP CODE, OF ASSIGNEE)


		Shares
of the Common Stock represented by the within Certificate, and do(es) 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(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER.

SIGNATURES GUARANTEED:


By

		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.