For value received, I, ________(1)______________, of __________(2)___________, assign to ________(3)_______, of ________(4)__________, assignee __(5)__ shares of stock of __________(6)___________, which shares stand in my name on the books of such corporation and are represented by certificate No. ___(7)___.

I warrant that the assigned certificate is genuine and, to my knowledge, valid, and that I have the legal right to transfer it.

I appoint assignee my attorney in fact to effect a transfer of the assigned shares on the books of _____(8)________ with full power of substitution in the premises.

Dated _________(9)___________, 19__(10)_.

_____________(11)_____________

NOTICE

The information in this document is designed to provide an outline that you can follow when formulating business or personal plans. Due to the variances of many local, city, county and state laws, we recommend that you seek professional legal counseling before entering into any contract or agreement.