EX-99.15 3 mh_ex9915-70417.htm EXHIBIT 99.15 - STOCK POWER FORM Exhibit 99.15 - Stock Power Form
 
Exhibit 99.15
STOCK POWER FORM
 
VALUE RECEIVED, I/we hereby sell, assign and transfer to (1):  
                          41-2216884                                  
Social Security # or Tax I.D. # of New Owner.

 
(2)
MH FINANCIAL ASSOCIATES, LLC        
Print/Type all Names & Address of NEW OWNERS, Indicate if joint, trust or custodian account
 
5300 Meadows Road, Suite 400        
Lake Oswego    OR   97035    
City           State     Zip Code
 
Transfer (3) _______________ certificate shares represented by the enclosed certificate number(s) (4) ___________________, AND/OR (5) __________________ book-entry shares (including shares held for you in a divided reinvestment or other plan)
 
Registered to (6)_________________________________________________
 
Account number (7) ______________________________________________           
 
The undersigned does (do) hereby irrevocably constitute and appoint _______________________ attorney to transfer the said stock on the books of  
                        microHelix, Inc.    with full power of substitution in the premises.
     Company Name
 
Signature(s) of Registered Owners: Please sign as name appears on registration. Joint owners should each sign. When signing as attorney, executor, administrator, trustee or guardian, please give full title of such.
 

 
(8) _______________________________________________  Date: _______________________
    Signature or registered holder of authorized representative   

      _______________________________________________  Telephone: __________________
    Signature of Joint Owner

Affix Medallion Signature Guarantee by a financial institution enrolled in an approved Medallion Program pursuant to S.E.C. Rule 17Ad-15.