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EXHIBIT 4.1
NUMBER SHARES
THE PLASTIC SURGERY COMPANY
INCORPORATED UNDER THE LAWS OF THE STATE OF GEORGIA
AUTHORIZED 100,000,000 SHARES OF COMMON STOCK, NO PAR VALUE
This certifies that _________________________________________________ is the
registered holder of __________________________________________________Shares of
Common Stock, no par value per share, of The Plastic Surgery Company,
transferable only on the books of the Corporation by the holder hereof in person
or by 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. 19____
______________________________________ SEAL _________________________________
President Secretary
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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 UNIF GIFT MIN ACT -- ____________ Custodian _______________
(Cust) (Minor)
TEN ENT -- as tenants by the entireties under Uniform Gifts to Minors
JT TEN -- as joint tenants with right of Act __________________________________
survivorship and not as tenants (State)
in common
Additional abbreviations may also be used though not in the above list.
For value received, _________________________________ hereby sell, assign
and transfer unto
PLEASE INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING NUMBER OF ASSIGNEE
_______________________________________________________________________________
_______________________________________________________________________________
PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS 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
___________________________________
NOTICE: THE SIGNATURE TO 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.
