FOR VALUE RECEIVED,			hereby sells, assigns
and transfers unto
	Shares of the Common Stock of
	standing in our name on the books of
said Corporation represented by Certificate No.	herewith, and do hereby irrevocably
constitute and appoint		as attorney to transfer
the said stock on the books of said Corporation with full power of substitution in the premises.
Dated

In presence of    ___________________________________ ________________________________________________ Name:
Title: