EX-4.5 2 y42914a1ex4-5.txt FORM OF COMMON STOCK CERTIFICATE 1 EXHIBIT 4.5
Certificate No. _____For _______ Shares Issued to__________Transferred from__________________________________/_________/____________ No. Original Certificate No. Original Shares No. of Shares Transferred Dated_______________,______ Receipt acknowledged___________________________________________________________________________________
Transfer Restricted - See Reverse Side Hereof -------------------------------------------------------------------------------- NUMBER INCORPORATED UNDER THE LAWS OF SHARES 0 0.00 Delaware TRAVELCENTERS OF AMERICA, INC. Common Shares, par value $.00001 per share This Certifies that SPECIMEN is the owner of ZERO and 00/100 fully paid and non-assessable Shares of the Capital Stock of the above named Corporation transferable only on the books of the Corporation by the holder hereof in person or by duly authorized Attorney upon surrender of this Certificate properly endorsed. In Witness Whereof, the said Corporation has caused this Certificate to be signed by its duly authorized officers and its Corporate Seal to be hereunto affixed this ______________ day of ______________ A.D._______ ----------------------- ---------------------- Secretary President ------------------------------------------------------------------------------- 2 EXPLANATION OF ABBREVIATIONS The following abbreviations, when used in the inscription of ownership on the face of this certificate, shall be construed as if they were written out in full according to applicable laws or regulations. Abbreviations, in addition to those appearing below, may be used.
JT TEN As joint tenants with right of survivorship and TEN ENT As tenants by the entireties not as tenants in common UNIF GIFT MIN ACT Uniform Gifts to Minors Act TEN COM As tenants in common CUST Custodian for For Value Received, _________________________________________________________ hereby sell, assign and transfer unto PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE ________________________________________________________________________________ Shares represented by the within Certificate, and do hereby irrevocably constitute and appoint __________________________________ Attorney to transfer the said Shares on the books of the within named Corporation with full power of substitution in the premises. Dated _______________________________ In presence of _____________________________________ _________________________________________
CERTIFICATE FOR ____________ SHARES OF TRAVELCENTERS OF AMERICA, INC. ISSUED TO SPECIMEN DATED _____________________