AltheaDx, Inc. - FORM S-1/A - EX-4.1 - January 22, 2015

Attached files

file filename
S-1/A - S-1/A - AltheaDx, Inc.d749180ds1a.htm
EX-10.6 - EX-10.6 - AltheaDx, Inc.d749180dex106.htm
EX-10.8 - EX-10.8 - AltheaDx, Inc.d749180dex108.htm
EX-10.7 - EX-10.7 - AltheaDx, Inc.d749180dex107.htm
EX-1.1 - EX-1.1 - AltheaDx, Inc.d749180dex11.htm
EX-3.1 - EX-3.1 - AltheaDx, Inc.d749180dex31.htm
EX-5.1 - EX-5.1 - AltheaDx, Inc.d749180dex51.htm
EX-23.1 - EX-23.1 - AltheaDx, Inc.d749180dex231.htm

Exhibit 4.1

LOGO

 

SHARES

 

ADX

 

COMMON STOCK COMMON STOCK

 

INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE CERTAIN SEE REVERSE DEFINITIONS FOR

 

CUSIP 021477 10 4

 

THIS CERTIFIES THAT

 

IS THE RECORD HOLDER OF

 

FULLY PAID AND NON-ASSESSABLE SHARES OF COMMON STOCK, $0.0001 PAR VALUE, OF BY:

 

ALTHEADX, INC.

 

transferable on the books of the Corporation by the holder hereof in person or by duly authorized attorney upon surrender of this Certificate AMERICAN properly endorsed. COUNTERSIGNED

 

STOCK

 

This Certificate is not valid unless countersigned and registered by the Transfer Agent and Registrar. AND

 

WITNESS the facsimile signatures of the Corporation’s duly authorized officers. (Brooklyn,TRANSFER

 

TRANSFER

 

Dated: &

 

AGENT NY) REGISTERED: TRUST

 

AUTHORIZED AND

 

COMPANY, LLC

 

PRESIDENT AND CHIEF OPERATING OFFICER CHIEF FINANCIAL OFFICER AND SECRETARY SIGNATURE REGISTRAR

The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws of regulations:

 

TEN COM

   

– as tenants in common

    UNIF GIFT MIN ACT–                      Custodian                     

TEN ENT

   

– as tenants by the entireties

    (Cust)                             (Minor)    

JT TEN

   

– as joint tenants with right of

    under Uniform Gifts to Minors    
      survivorship and not as tenants    Act                                                
  

   in common

    (State)                    

 

Additional abbreviations may also be used though not in the above list.

 

For value received,                                                                                                hereby sell(s), assign(s) and transfer(s) unto

 

PLEASE INSERT SOCIAL SECURITY OR OTHER

IDENTIFYING NUMBER OF ASSIGNEE

 

         
          
                
                

PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, OF ASSIGNEE

 

                

                

 

                                                                                                                                                                                                          Shares

of the common stock represented by the within Certificate and do(es) hereby irrevocably constitute and appoint

                                                                                                                                                                                                        Attorney

to transfer the said stock on the books of the within-named Corporation with full power of substitution in the premises.

 

Dated                                                                      

         

 

X  

 

X  

 

NOTICE:   THE SIGNATURE TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER.
 
 

 

SIGNATURE(S) GUARANTEED:

 

THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 17Ad-15.

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