In witness whereof ________ have hereunto set ________ hand ____ and seal ____ in the city of ________, the ____ day of ________, in the year of our Lord, 19__.
State of Ohio,
City and County of ________ss.:
On the ____ day of ________, 19__, personally appeared before me ________, to me known to be the person ________ described in, and who executed the within instrument, and acknowledged the execution of the same for the uses and purposes therein mentioned.
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Certificate of Stock
No. ________ No. of shares ________
Par value of each, $________
The ________ Company:
This is to certify that ________ is the owner of ________ ________ shares of the capital stock of the ________ Company, transferable only on the books of the company by the holder thereof, in person or by attorney, on the surrender of this certificate.
In witness whereof, the said company has caused its corporate seal to be affixed, hereto, and this certificate to be signed by its president and treasurer.
________, N.Y. ________, 19__.