Assignment and Transfer of Stock Certificate

OF STOCK CERTIFICATE





FOR VALUE RECEIVED, the undersigned hereby sells, assigns

and transfers to _, (_) shares of the stock of _ (Corporation)

standing in the name of the undersigned on the books of the

Corporation and represented by Certificate No. _.

The undersigned hereby and irrevocably constitutes and

appoints _, attorney-in-fact, to transfer the said stock on

the books of the within named Corporation with full power of

substitution in the premises.



Dated: _



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In the presence of:




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