EX-4.1 2 a2046803zex-4_1.txt EXHIBIT 4.1 See reverse for ---------------- certain definitions CUSIP 123159 105 ---------------- Burzynski Research Institute Inc. INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE NUMBER SHARES This Certifies That COPY is the owner of fully paid and non-assessable shares of Burzynski Research Institute Inc. transferable on the books of the Corporation by the holder hereof in person or by duly authorized attorney upon surrender of this certificate properly endorsed. This certificate is not valid until countersigned by the Transfer Agent. Witness the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers. Dated [BURZYNSKI RESEARCH INSTITUTE INC. CORPORATE SEAL 1980 DELAWARE] /s/ Barbara Mattox /s/ Stanislaw R. Burzynski --------------------------- -------------------------- Secretary President Countersigned General Securities Transfer Agency, Inc. P.O. Box 3805, Albuquerque, New Mexico 87190 By ________________________________________________ Transfer Agent & Registrar Authorized Signature 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 TEN ENT -- as tenants by the entireties JT TEN -- as joint tenants with right of survivorship and not as tenants in common UNIF GIFT MIN ACT - _______ Custodian _______ (Cust) (Minor) under Uniform Gifts to Minors Act ________________________ (State) Additional abbreviations may also be used though not in the above list. COPY PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE --------------------------------- --------------------------------- For Value received, __________________________ hereby sell, assign and transfer unto ___________________________________________________________________________ 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: __________________________ Signature _________________________________________ Signature Guaranteed: SIGNATURE MUST BE GUARANTEED BY A COMMERCIAL BANK OR MEMBER FIRM OF ONE OF THE FOLLOWING STOCK EXCHANGES: NEW YORK STOCK EXCHANGE, PACIFIC COAST STOCK EXCHANGE, AMERICAN STOCK EXCHANGE, MIDWEST STOCK EXCHANGE. ________________________________________________________________________________ NOTICE: The signature of 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.