EX-4.1 2 v318344_ex4-1.htm EXHIBIT 4.1

 

Exhibit 4.1

 

 

NUMBER TSH TILE SHOP HOLDINGS, INC. ORGANIZED UNDER THE LAWS OF THE STATE OF DELAWARE SHARES CUSIP 88677Q 10 9 SEE REVERSE FOR CERTAIN DEFINITIONS THIS CERTIFIES THAT is the owner of FULLY PAID AND NON-ASSESSABLE SHARES OF COMMON STOCK, $0.0001 PAR VALUE, OF TILE SHOP HOLDINGS, INC. transferable on the books of the Corporation in person or by duly authorized attorney upon the surrender of this Certificate properly endorsed. This Certificate is not valid until countersigned by the Transfer Agent and registered by the Registrar. WITNESS the facsimile seal of the Corporation and the facsimile signature of its duly authorized officer. Dated: TILE SHOP HOLDINGS, INC. SEAL 2012 DELAWARE CORPORATE Chief Executive Officer COUNTERSIGNED AND REGISTERED: CONTINENTAL STOCK TRANSFER & TRUST COMPANY (JERSEY CITY, NJ) TRANSFER AGENT AND REGISTRAR BY: AUTHORIZED OFFICER

 

 
 

 

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 or 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 survivorship and not as tenants in common   under Uniform Gifts to Minors
Act __________________
                      (State)

 

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

 

For value received, _________________________________________________ hereby sell, assign and transfer unto

 

PLEASE INSERT SOCIAL SECURITY OR OTHER  
IDENTIFYING NUMBER OF ASSIGNEE  
   
   
   

 

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

 

of the common stock represented by the within Certificate, and do 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,    

 

     
  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.