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Assignment & Transfer Of Stock Certificate
FOR VALUE RECEIVED, the undersigned hereby sells, assigns and transfers to [Name], [--] shares of the stock of [Corporation] standing in the name of the undersigned on the books of the Corporation and represented by Certificate No. [Number].
The undersigned hereby and irrevocably constitutes and appoints [Name], attorney-in-fact, to transfer the said stock on the books of the within named Corporation with full power of substitution in the premises.
In the presence of:
This Section for Notary:
STATE OF -------)
) ss: [date]
COUNTY OF ------)
On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
[Name of Notary Public]
My commission expires: [date]