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FORM211.DOC
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1986-02-18
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ASSIGNMENT OF STOCK
For good and valuable consideration, receipt of which is
hereby acknowledged, I, ____________________________ the
undersigned, residing at ___________________________ hereby sell,
assign and transfer to _____________________________, residing at
_______________________________, (_____) shares of the
stock of _________________________ [the "Corporation"] standing
in my name on the books of the Corporation, represented by
Certificate No. ______________, and hereby irrevocably constitute
and appoint __________________, attorney-in-fact to transfer the
stock on the books of the within named Corporation, with full
power of substitution in the premises.
Dated: _______________________________
In the presence of:
________________________
Form 211