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STOCK POWER FORM The undersigned hereby assigns and transfers to
Whitman-Walker Clinic:
Shares of Stock
______ shares of the common stock of _________________ represented by Certificate No.(s) ____________________ inclusive, standing in the name of the undersigned on
the books of said Corporation.
OR
Bond
_______ bond of ______________________________ in the principal amount of $______, Certificate No._______
standing in the name of the undersigned on the books of said Corporation.
The undersigned does (do) hereby irrevocably constitute and appoint Salomon Smith Barney Attorney to transfer the said stock(s), bond(s), or
debenture(s), as the case may be, on the books of said Corporation with full power of substitution in the premises.
Signed___________________________Date______________
Donor
Signed___________________________Date______________
Donor (joint-owner) |
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