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IRREVOCABLE STOCK/BOND POWER FORM
Date_________________________
For value received, the Undersigned does (do) hereby sell, assign and
transfer to
______________________________________________________________________________
______________________________________________________________________________
Social Security or Taxpayer
Identifying No_____________________
If Stock, >
______shares of the ________stock of _________________________________
complete
this
represented by Certificate(s) No.(s)
______________________________inclusive,
portion
standing in the name of the undersigned on the books of said Company.
If Bonds,>
_________________________bonds of________________________________
complete
this
in the principal amount of $__________,
No.(s)_____________________inclusive,
portion
standing in the name of the undersigned on the books of said Company.
The undersigned does (do) hereby irrevocably constitute and appoint
_____________________
_____________________________________ attorney to transfer the said stock
or bond(s), as
the case may be, on the books of said Company, with full power of
substitution in the premises.
In Presence of
__________________________________(SEAL)
(Person executing this power signs here)
__________________________________
S I G N A T U R E G U A R A N T E E D
IMPORTANT – READ CAREFULLY
____________________________________
(Name of Bank, Trust Company or Broker)
The signature(s) to this Power must
correspond with the name(s) as written
upon the face of the stock certificate(s)
____________________________________
or bond(s), as the case may be, in every
(Official Signature)
particular without alteration or
enlargement or any change whatever. |