Nevada
|
|
000-22711
|
|
76-0640970
|
(State
or other jurisdiction of Incorporation)
|
|
(Commission
File Number)
|
|
(IRS
Employer Identification Number)
|
701
North Post Oak, Road, Suite 600, Houston, Texas
|
77024
|
|
(Address
of principal executive offices)
|
(Zip
Code)
|
¨
|
Written
communications pursuant to Rule 425 under the Securities Act (17
CFR
230.425)
|
¨
|
Soliciting
material pursuant to Rule 14a-12 under the Exchange Act (17 CFR
240.14a-12)
|
¨
|
Pre-commencement
communications pursuant to Rule 14d-2(b) under the Exchange Act
(17 CFR
240.14d-2(b))
|
¨
|
Pre-commencement
communications pursuant to Rule 13e-4(c) under the Exchange Act
(17 CFR
240.13e-4(c))
|
Exhibit
|
Exhibit
|
|
Number
|
Name
|
|
Designation
Certificate of Series C Preferred Stock.
|
||
Warrant—SAI
Corporation.
|
||
Warrant---Stephen Sperco.
|
||
Warrant—Gilbert Gertner.
|
||
Preferred
Stock Purchase Agreement—SAI Corporation.
|
||
4.6
|
Preferred
Stock Purchase Agreement—Stephen Sperco.
|
|
4.7
|
Series
C Preferred Stock certificates—SAI Corporation and Stephen
Sperco.
|
|
BLUEGATE
CORPORATION
|
|
|
(signed)
|
|
Date:
July 2, 2007
|
/s/
Charles Leibold
|
|
|
Charles Leibold
|
|
|
Chief
Financial Officer
|
ROSS MILLER
Secretary
of State
|
|
SCOTT W. ANDERSON
Deputy
Secretary for Commercial
Recordings
|
June
25, 2007
|
||||
Job
Number
|
Corporation
Number
|
|||
C20070625-2136
|
C173-1985
|
|||
Filing
Description
|
Document
Filing
Number
|
Date/Time
of Filing
|
||
Designation
|
20070433952-45
|
June25,
2007 03:15:39PM
|
Corporation
Name
|
Resident
Agent
|
|
BLUEGATE
CORPORATION
|
CORPORATION
TRUST COMPANY OF NEVADA
|
Respectfully,
|
||
/s/
Ross Miller
|
||
ROSS MILLER
|
||
Secretary
of State
|
BLUEGATE- DANA KIRKPATRICK
|
June
26, 2007
|
701
NORTH POST OAK RD STE 630
|
|
HOUSTON,
TX 77024
|
Job
|
C20070625-2136
|
NV
Corp Filing Acknowledgement(s):
|
1
|
File
Stamped Copy(s):
|
1
|
ROSS
MILLER
Secretary
of State
|
|
SCOTT W. ANDERSON
Deputy
Secretary
for
Commercial Recordings
|
June
26, 2007
|
Job
Number:
|
C20070625-2136
|
Description
|
Document
Number
|
Filing
Date/Time
|
Qty
|
Price
|
Amount
|
Designation
|
20070433952-45
|
6/25/2007
3:15:39
PM
|
1
|
$175.00
|
$175.00
|
24
Hour
Expedite
|
20070433952-45
|
6/25/2007
3:15:39
PM
|
1
|
$125.00
|
$125.00
|
Total
|
$300.00
|
Type
|
Description
|
Amount
|
Credit
|
213815107062605069248
|
$300.00
|
Total
|
$300.00
|
|
ROSS MILLER
Secretary
of State
204
North Carson Street, Ste 1
Carson
City, Nevada 89701-4299
(775)
684 5708
Website:
secretaryofstate.biz
|
Filed
in the office
of
/s/
Ross Miller
Ross Miller
Secretary
of State
State
of
Nevada
|
Document
Number
20070433952-46
|
Filing
Date and Time
06/25/2007
3:15
PM
|
|
Entity
Number
C173-1985
|
Certificate
of Designation
|
|
(PURSUANT
TO NRS 78.1955)
|
USE
BLACK INK ONLY – DO NOT HIGHLIGHT
|
ABOVE
SPACE IS FOR OFFICE USE ONLY
|
|
3.
Effective date of filing (optional):
|
|||
(must
not be later than 30 days after the certificate is filled)
|
|||
|
|||
4,
Officer Signature (Required):
|
X
/s/ illegible
|
1.
|
No
dividends on Series C Convertible Preferred Stock.
There are no
dividends on
Series
C Convertible Preferred
Stock.
|
2.
|
Conversion
of Series C Convertible Preferred
Stock.
|
(a)
|
Each
holder of shares of Series C Convertible Preferred Stock may, at
his
option and at any time and from time to time, convert any or
all such shares, into fully paid and non-assessable shares of
the Company's Common Stock at a conversion ratio of 25,000 shares
of
Common Stock for each share of Series C Convertible Preferred Stock.
Fractional Conversions are
permitted.
|
(b)
|
To
exercise his conversion
privilege, the holder of any shares of
Series C
Convertible Preferred
Stock shall surrender to the Company
during regular
business hours at
the principal executive offices of the
Company
or the offices of the
transfer agent for the Series C Convertible
Preferred
Stock or at such other
place as may be designated by the
Company,
the certificate or
certificates for the shares to be converted, duly
endorsed
for transfer to the
Company (if required by it), accompanied by
written
notice stating that the
holder irrevocably elects to convert such
shares. Conversion shall
be deemed to have been effected on the date when such delivery
is made,
and such date is referred to herein as the "Conversion Date." Within
five
(5) business days after the date on which such delivery is made,
the
Company shall issue and send (with receipt to be acknowledged)
to the
holder thereof for the holder's designee, at the address designated
by
such holder, a certificate or certificates for the number of full
and
fractional shares of Common Stock to which the holder is entitled
as a
result of such conversion. The holder shall be deemed to have
become a stockholder of record of the number of shares of Common
Stock
into which the shares of Series C Convertible Preferred Stock have
been
converted on the applicable Conversion Date unless the transfer
books of
the Company are closed on that date, in which event he shall be
deemed to
have become a stockholder or record of such shares on the next
succeeding
date on which the transfer books are open. Upon conversion of
only a portion of the number of share of Series C Convertible Preferred
Stock represented by a certificate or certificates surrendered
for conversion, the Company shall within three (3) business days
after the
date on which such delivery is made, issue and send (with receipt
to be
acknowledged) to the holder thereof or the holder's designee, at
the
address designated by such holder, a new certificate covering the
number
of shares of Series C Convertible Preferred Stock representing
the
unconverted portion of the certificate or certificates so
surrendered,
|
(c)
|
The
Company shall at all times reserve for issuance and maintain available,
out of its authorized but unissued Common Stock, solely for the
purpose of
effecting the conversion of the Series C Convertible Preferred
Stock, the
full number of shares of Common Stock deliverable upon the conversion
of
all Series C Convertible Preferred Stock from time to time outstanding.
The Company shall from time to time (subject to obtaining necessary
director and stockholder action), in accordance with the laws of
the State
of Nevada, increase the authorized number of shares of its Common
Stock if
at any time the authorized number of shares of its Common Stock
remaining
unissued shall not be sufficient to permit the conversion of all
of the
shares of Series C Convertible Preferred Stock at the time
outstanding.
|
(d)
|
If
any shares of Common Stock to be reserved for the purpose of conversion
of
shares of Series C Convertible Preferred Stock require listing
with, or
approval of, any governmental authority, stock exchange or other
regulatory body under any federal or state law or regulation or
otherwise,
before such shares may be validly issued or delivered upon conversion,
the
Company will in good faith and as expeditiously as possible meet
such
listing or approval, as the case may
be.
|
(e)
|
All
shares of Common Stock which may be issued upon conversion of the
shares
of Series C Convertible Preferred Stock will upon issuance by the
Company
be validly issued, fully paid and non-assessable and free from
all taxes,
lieus and charges with respect to the issuance
therefor.
|
(f)
|
In
case any shares of Series C Convertible Preferred Stock shall be
converted
pursuant hereto, or purchased or otherwise acquired by the Company,
the
shares so converted, purchased or acquired shall be restored to
the status
of authorized but unissued shares of preferred stock, without designation
as to class or series, and may thereafter be reissued, but not
as shares
of Series C Convertible Preferred
Stock.
|
(g)
|
The
conversion ratio of the Series C Convertible Preferred Stock into
Common
Stock of the Company shall be subject to adjustment from time to
time as
follows:
|
(i)
|
Stock
Splits, Dividends and Combinations.
In the event that the Company
shall at any time subdivide the outstanding shares of Common Stock,
or
shall pay or make a dividend or distribution on any class or capital
stock
of the Company in Common Stock, the conversion ratio in effect
immediately
prior to such subdivision or the issuance of such dividend shall
be
proportionately decreased, and in case the Company shall at any
time
combine the outstanding shares of Common Stock, the conversion
ratio in
effect immediately prior to such combination shall be proportionately
increased, effective at the close of business on the date of such
subdivision, dividend or combination, as the case may
be.
|
(ii)
|
Non-Cash
Dividends, Stock Purchase Rights, Capital
Reorganization and
Dissolutions.
In the
event:
|
(a)
|
that
the Company shall take a record of the holders of its Common Stock
for the
purpose of entitling them to receive a dividend, or any other distribution
payable otherwise than in case;
or
|
(b)
|
that
the Company shall take a record of the holders of its Common Stock
for the
purpose of entitling them to subscribe for or purchase any shares
of stock
of any class or other securities, or to receive any other rights;
or
|
(c)
|
of
any capital reorganization of the Company, reclassification of
the capital
stock of the Company (other than a subdivision or combination of
its
outstanding shares of Common Stock), consolidation or merger of
the
Company with or into another corporation, share exchange for all
outstanding shares of Common Stock under a plan of exchange to
which the
Company is a party, or conveyance of all or substantially all of
the
assets of the Company to another corporation;
or
|
(d)
|
of
the voluntary or involuntary dissolution, liquidation or winding
up of the
Company;
|
3.
|
Voting
of Series C Convertible Preferred Stock.
The shares of Series C
Convertible Preferred Stock shall be entitled to vote, together
with the
shares of the Company's Common Stock, on all matters presented
at any
annual or special, meeting of stockholders of the Company, or may
act by
written consent in the same manner as the holders of the Company's
Common
Stock; upon the following basis: each holder of Series C Convertible
Preferred Stock shall be entitled to cast such number of votes
for each
share of Series C Convertible Preferred Stock held by such holder
on the
record date fixed for such meeting, or on the effective date of
such
written consent, as shall be equal to fifteen (15) times the number
of
shares of the Company's Common Stock into which each of such holder's
shares of Series C Convertible Preferred Stock is convertible immediately
after the close of business on the record date fixed for such meeting
or
the effective date of such written consent The Series C Convertible
Preferred Stock and any other stock having voting rights shall
vote
together as one class, except as provided by
law,
|
4.
|
Liquidation
Rights.
|
(a)
|
In
the event of any voluntary or involuntary liquidation, dissolution
or
winding up of the Company, the holders of shares of Series C Convertible
Preferred Stock then outstanding shall be entitled to receive out
of
assets of the Company available for distribution to stockholders,
before
any distribution of assets is made to holders of any other class
of
capital stock of the Company, an amount equal to $12,500.00 per
share
("Liquidation Amount").
|
(b)
|
A
consolidation or merger of the Company (in the event that the Company
is
not the surviving entity) or sale of all or substantially all of
the
Company's assets shall be regarded as
a liquidation,
dissolution or winding up of the affairs of the Company within
the meaning
herein. In the event of such a liquidation as contemplated herein,
the
holders of Series C Convertible Preferred Stock shall be entitled
to
received an amount equal to the Liquidation
Amount.
|
(c)
|
In
the event of any voluntary or involuntary liquidation, dissolution
or
winding up of the Company which involves the distribution of assets
other
than cash, the Company shall promptly engage competent independent
appraisers to determine the value of the assets to be distributed
to the
holders of shares of this Series C Convertible Preferred Stock,
other
preferred stock, and the holders of shares of Common Stock. The
Company
shall, upon receipt of such appraiser's valuation, give prompt
written
notice to each holder of shares of Series C Convertible Preferred
Stock of
the appraiser's valuation.
|
5.
|
No
Redemption by the Company
. Series C Convertible Preferred
Stock is not
redeemable by the
Company.
|
|
Blugate
Corporation
|
|
/s/ Stephen J. Sperco | ||
Stephen J. Sperco,
Chief Executive Officer
|
||
/s/ Charles E. Leibold | ||
Charles E. Leibold,
Chief Financial Officer
|
THE
STATE OF TEXAS
|
§
|
|
§
|
COUNTY
OF HARRIS
|
§
|
Barbara
C. Fullerton
Notary
Public
State
of Texas
My
Commission Expires
November
13, 2007
|
/s/
Barbara C. Fullerton
|
||
NOTARY
PUBLIC IN AND FOR THE STATE OF TEXAS
|
THE
STATE OF TEXAS
|
§
|
|
§
|
COUNTY
OF HARRIS
|
§
|
Barbara
C. Fullerton
Notary
Public
State
of Texas
My
Commission Expires
November
13, 2007
|
/s/
Barbara C. Fullerton
|
||
NOTARY
PUBLIC IN AND FOR THE STATE OF TEXAS
|
Warrant
No.: PP(4)-1
|
Right
to Purchase: 1,000,000 common shares
|
|
Date:
June 28, 2007
|
(A)
|
=
the closing bid price on the trading day preceding the date of
such
election;
|
(B)
|
=
the Exercise Price of the Warrants, as adjusted;
and
|
(X)
|
=
the number of shares of Common Stock issuable upon exercise of
the
Warrants in accordance with the terms of this
Warrant.
|
BLUEGATE
CORPORATION
|
ATTEST:
|
||
By:
|
/s/ William E. Koehler | /s/ Barbara C. Fullerton | |
Name:
|
William E. Koehler
|
Secretary
|
|
Title:
|
President
and Chief Operating Officer
|
To:
|
Bluegate
Corporation
|
|
|
|
[HOLDER] | |||||
By:
|
|||||
Name:
|
|||||
Title:
|
|||||
Dated:
|
Warrant
No.: PP(4)-2
|
Right
to Purchase: 5,000,000 common
shares
|
(A)
|
=
the closing bid price on the trading day preceding the date of
such
election;
|
(B)
|
=
the Exercise Price of the Warrants, as adjusted;
and
|
(X)
|
=
the number of shares of Common Stock issuable upon exercise of
the
Warrants in accordance with the terms of this
Warrant.
|
BLUEGATE
CORPORATION
|
|||
By: | /s/ William E. Koehler | /s/ Barbara C. Fullerton | |
Name:
|
William E. Koehler
|
Secretary
|
|
Title:
|
President
and Chief Operating Officer
|
To:
|
Bluegate
Corporation
|
[HOLDER] | ||||
By:
|
||||
Name:
|
||||
Title:
|
||||
Dated:
|
BLUEGATE
CORPORATION
|
No.
E-07-07
|
|
STOCK
OPTION AGREEMENT
|
1.
|
Grant
of Option.
|
2.
|
Vesting.
|
3.
|
Termination
of Option.
|
(a)
|
The
Option and all rights hereunder with respect thereto, to the extent
such
Option has vested, shall terminate and become null and void after
the
expiration of five (5) years from the Date of Grant (the "Option
Term").
To the extent that the Option has not vested in accordance with
Section 2
above, then the non-vested portion of the Option shall terminate
and
become null and void upon the termination of the Grantee as an
employee,
officer or director of the Company.
|
(b)
|
In
the event of the death of the Grantee, the Option may be exercised
by the
Grantee's legal representative(s), but only to the extent that
the Option
would otherwise have been exercisable by the
Grantee.
|
(c)
|
In
the event the Board (or Committee, if any) finds by a majority
vote after
full consideration of the facts that Grantee, before or after termination
of his employment with the Company or an Affiliate for any reason
(i)
committed or engaged in fraud, embezzlement, theft, commission
of a
felony, or proven dishonesty in the course of his employment by
the
Company or any subsidiary or affiliate of the Company, which conduct
damaged the Company or subsidiary or affiliate, or disclosed trade
secrets
of the Company its subsidiary or its affiliate, or (ii) participated,
engaged in or had a material, financial or other interest, whether
as an
employee, officer, director, consultant, contractor, shareholder,
owner,
or otherwise, in any commercial endeavor anywhere which is competitive
with the business of the Company or a subsidiary or Affiliate without
the
written consent of the Company, the Grantee shall forfeit all outstanding
Options. Clause (ii) shall not be deemed to have been violated
solely by
reason of the Grantee's ownership of stock or securities of any
publicly
owned corporation, if that ownership does not result in effective
control
of the corporation.
|
4.
|
Exercise
of
Options.
|
(a)
|
The
Grantee may exercise the Option with respect to all or any part
of the
number of Option Shares then exercisable hereunder by giving the
Secretary
of the Company written notice of intent to exercise. The notice
of
exercise shall specify the number of Option Shares as to which
the Option
is to be exercised and the date of exercise thereof, which date
shall be
at least five days after the giving of such notice unless an earlier
time
shall have been mutually agreed upon. Notwithstanding the foregoing,
an
Option granted under this Agreement may be exercised in increments
of not
less than 10% of the full number of Shares as to which it can be
exercised. A partial exercise of an Option will not affect the
Grantee's
right to exercise the Option from time to time in accordance with
this
Agreement as to the remaining Shares subject to the
Option.
|
(b)
|
Full
payment (in U.S. dollars) by the Grantee of the option price for
the
Option Shares purchased shall be made on or before the exercise
date
specified in the notice of exercise in cash, or certified or cashier's
check or money order, or, with the prior written consent of the
Board, in
whole or in part through the surrender of previously acquired shares
of
Stock at their fair market value on the exercise
date.
|
(c)
|
Notwithstanding
any of the other provisions hereof, Grantee agrees that he will
not
exercise this Option and that the Company will not be obligated
to issue
any Option Shares pursuant to this Stock Option Agreement, if the
exercise
of the Option or the issuance of such Option Shares would constitute
a
violation by the Grantee or by the Company of any provision of
any law or
regulation of any governmental authority or national securities
exchanges.
Upon the acquisition of any Option Shares pursuant to the exercise
of the
Option herein granted, Grantee will enter into such written
representations, warranties and agreements as the Company may reasonably
request in order to comply with applicable securities laws with
this Stock
Option Agreement.
|
5.
|
Piggyback
Registration Rights.
|
6.
|
Adjustment
of and Changes in Stock of the
Company.
|
7.
|
Fair
Market Value.
|
|
8.
|
No
Rights
of
Stockholders.
|
|
9.
|
Non-Transferability
of Option.
|
10.
|
Disputes.
|
11.
|
Notice.
|
12.
|
Governing
Law.
|
Bluegate
Corporation
|
||
By: | ||
/s/
William E. Koehler
|
||
William E. Koehler | ||
President and COO | ||
Grantee:
|
||
/s/ Gilbert Gertner | ||
Gilbert
Gertner
|
1.
|
Private
Placement
|
2.
|
Subscription.
|
3.
|
Conditions
to Offer.
|
4.
|
Representations
and Warranties of the
Investor.
|
5.
|
Representations
and Warranties of the
Company.
|
6.
|
Covenants
of the Company.
|
7.
|
No
Waiver.
|
8.
|
Revocation.
|
9.
|
Termination
of Subscription
Agreement.
|
10.
|
Miscellaneous.
|
11.
|
Certification.
|
SAI
Corporation
|
If other than individual check one and | |||
Name
of Investor (Print)
|
indicate capacity of signatory under the signature: | |||
£
|
Trust
|
|||
£
|
Estate
|
|||
Name
of Joint Investor (if any) (Print)
|
£
|
Uniform
Gifts to Minors Act, State of
|
||
£
|
Attorney-in-fact
|
|||
/s/
Stephen J. Sperco
|
S
|
Corporation
|
||
Signature
of Investor
|
£
|
Other
|
||
If Joint Ownership, Check one: | ||||
£
|
Joint
Tenants with Right of Survivorship
|
|||
£
|
Tenants
in Common
|
|||
Signature
of Joint Investor (if any)
|
£
|
Tenants
by the Entirety
|
||
£
|
Community
by Property
|
|||
President
|
||||
Capacity
of Signatory (if applicable)
|
Backup Withholding Statement: | |||
£
|
Please
check this box only if the investor is subject to backup
withholding
|
|||
|
||||
Social
Security or Taxpayer Identification Number
|
||||
Foreign Person: | ||||
Investor
Mail Address:
|
£
|
Please
check this box only if the investor is a
|
||
SAI
Corporation
|
nonresident
alien, foreign corporation, foreign
|
|||
180
North Stetson Avenue. Suite 700
|
partnership,
foreign trust or foreign estate
|
|||
Street
Address
|
Chicago,
|
IL
|
60601
|
Share
and Warrant Registration Name(s) and Amounts:
|
|
City
|
State
|
Zip
Code
|
Telephone:
(312) 602-7000
|
Fax:
( )
|
Name
|
Amount
|
1.
SAI Corporation
|
100%
|
Email:
|
2.
|
3.
|
4.
|
City
|
State
|
Zip
Code
|
Customer
Account No.
|
£
NASD Firm Reg. Rep.
|
No.
|
£
Other
Investor Representative
|
By:
|
/s/
Charles E. Leibold
|
|
Name:
|
CHARLES
E. LEIBOLD
|
|
Title:
|
CFO
|
1.
|
Private
Placement
|
2.
|
Subscription.
|
3.
|
Conditions
to Offer.
|
4.
|
Representations
and Warranties of the
Investor.
|
5.
|
Representations
and Warranties of the
Company.
|
6.
|
Covenants
of the Company.
|
7.
|
No
Waiver.
|
8.
|
Revocation.
|
9.
|
Termination
of Subscription
Agreement.
|
10.
|
Miscellaneous.
|
11.
|
Certification.
|
Stephen
J. Sperco
|
If other than individual check one and | |||
Name
of Investor (Print)
|
indicate capacity of signatory under the signature: | |||
£
|
Trust
|
|||
£
|
Estate
|
|||
Name
of Joint Investor (if any) (Print)
|
£
|
Uniform
Gifts to Minors Act, State of
|
||
£
|
Attorney-in-fact
|
|||
/s/
Stephen J. Sperco
|
£
|
Corporation
|
||
Signature
of Investor
|
£
|
Other
|
||
If Joint Ownership, Check one: | ||||
£
|
Joint
Tenants with Right of Survivorship
|
|||
£
|
Tenants
in Common
|
|||
Signature
of Joint Investor (if any)
|
£
|
Tenants
by the Entirety
|
||
£
|
Community
by Property
|
|||
|
||||
Capacity
of Signatory (if applicable)
|
Backup Withholding Statement: | |||
£
|
Please
check this box only if the investor is subject to backup
withholding
|
|||
|
||||
Social
Security or Taxpayer Identification Number
|
||||
Foreign Person: | ||||
Investor
Mail Address:
|
£
|
Please
check this box only if the investor is a
|
||
c/o
SAI Corporation
|
nonresident
alien, foreign corporation, foreign
|
|||
180
North Stetson Avenue, Suite 700
|
partnership,
foreign trust or foreign estate
|
|||
Street
Address
|
Chicago,
|
IL
|
60601
|
Share
and Warrant Registration Name(s) and Amounts:
|
|
City
|
State
|
Zip
Code
|
Telephone:
(312) 602-7000
|
Fax:
( )
|
Name
|
Amount
|
1.
Stephen J. Sperco
|
100%
|
Email:
|
2.
|
3.
|
4.
|
City
|
State
|
Zip
Code
|
Customer
Account No.
|
£
NASD Firm Reg. Rep.
|
No.
|
£
Other
Investor Representative
|
By:
|
Charles
E. Leibold
|
|
Name:
|
CHARLES
E. LEIBOLD
|
|
Title:
|
CFO
|
Dated:
|
June
28, 2007
|
Illegible
|
|
President
|
TEN
COM
|
- as
tenants in common
|
UNIF
GIFT MIN ACT -
|
Custodian
|
(Minor)
|
TEN
ENT
|
- as
tenants by the. entireties
|
under
Uniform Gifts to Minors Act
|
|
(State) |
JT
TEN
|
- as
joint tenants with right-of survivorship
|
|||
and not as tenants in common
|
For
value received, the undersigned hereby sells, assigns and transfers
unto
|
PLEASE
INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING
NUMBER OF ASSIGNEE
|
|
PLEASE
PRINT OR TYPEWRITE NAME AND ADDRESS OF ASSIGNEE
|
Shares
|
Represented
by the within Certificate, and hereby irrevocably constitutes and
appoints
|
Attorney
to transfer the said
|
Date,
|
In
presence of
|
Date:
|
June
28, 2007
|
Illegible
|
|
President
|
TEN
COM
|
- as
tenants in common
|
UNIF
GIFT MiN ACT -
|
Custodian
|
(Minor)
|
TEN
ENT
|
- as
tenants by the. entireties
|
under
Uniform Gifts to Minors Act
|
|
(State) |
JT
TEN
|
- as
joint tenants with right-of survivorship
|
|||
and not as tenants in common
|
For
value received, the undersigned hereby sells, assigns and transfers
unto
|
PLEASE
INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING
NUMBER OF ASSIGNEE
|
|
PLEASE
PRINT OR TYPEWRITE NAME AND ADDRESS OF ASSIGNEE
|
Shares
|
Represented
by the within Certificate, and hereby irrevocably constitutes and
appoints
|
Attorney
to transfer the said
|
Date,
|
In
presence of
|