ASSIGNMENT OF STOCK For good and valuable consideration, receipt of which is hereby acknowledged, I, ____________________________ the undersigned, residing at ___________________________ hereby sell, assign and transfer to _____________________________, residing at _______________________________, (_____) shares of the stock of _________________________ [the "Corporation"] standing in my name on the books of the Corporation, represented by Certificate No. ______________, and hereby irrevocably constitute and appoint __________________, attorney-in-fact to transfer the stock on the books of the within named Corporation, with full power of substitution in the premises. Dated: _______________________________ In the presence of: ________________________ Form 211