EX-4.1



 Exhibit 4.1 
 



 
  
 LH

 INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE 

CUSIP XXXXXX XX X 
 SEE REVERSE FOR CERTAIN DEFINITIONS AND LEGENDS 

This certifies that 
 is the record holder of 
 FULLY PAID AND
NONASSESSABLE SHARES OF COMMON STOCK, $0.001 PAR VALUE PER SHARE, OF 
 Lucira Health, Inc. 

transferable on the books of the Corporation 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 and registered by the Registrar. 
 WITNESS the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers. 
 Dated: 
 COUNTERSIGNED AND REGISTERED: 

AMERICAN STOCK TRANSFER & TRUST COMPANY, LLC 
 (BROOKLYN, NY) 
 TRANSFER AGENT AND REGISTRAR

 BY: 
 AUTHORIZED SIGNATURE 
 CHIEF EXECUTIVE OFFICER

 LUCIRAHEALTH, INC. 
 CORPORATE 
 SEAL 

February 20, 2013 
 DELAWARE 
 CHIEF FINANCIAL OFFICER 







 



 
  
 The
Corporation shall furnish without charge to each stockholder who so requests a statement of the powers, designations, preferences and relative, participating, optional or other special rights of each class of stock of the Corporation or series
thereof and the qualifications, limitations or restrictions of such preferences and/or rights. Such requests shall be made to the Corporation’s Secretary at the principal office of the Corporation. 

KEEP THIS CERTIFICATE IN A SAFE PLACE. IF IT IS LOST, STOLEN,OR DESTROYED THE CORPORATION WILL REQUIRE A BOND INDEMNITY AS
A CONDITION TO THE ISSUANCE OF A REPLACEMENT CERTIFICATE. 
 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: 
 Additional abbreviations may also be used though not in the above list. 
 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 
 COM PROP – as community property 

UNIF GIFT MIN ACT – ......................... Custodian ......................... 

(Cust) (Minor) 
 under Uniform Gifts to Minors 

Act.............................................................................. 

(State) 
 UNIF TRF MIN ACT – ................. Custodian (until age ..................) 
 (Cust) 
 .....................................
under Uniform Transfers 
 (Minor) 
 to Minors Act............................................................ 
 (State) 
 Additional abbreviations may also be used
though not in the above list. 
 FOR VALUE RECEIVED, _____________________________________________________ hereby
sell(s), assign(s) and transfer(s) unto 
 PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE

 (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, OF ASSIGNEE) 

Shares of the capital stock represented by within Certificate, and do hereby irrevocably constitute and appoint

 attorney-in-fact to transfer the said stock on the books of the within named Corporation with full power of
the substitution in the premises. 
 Dated 

Signature(s) Guaranteed: 
 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
WHATSOEVER. 
 By 
 THE SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION, (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE
GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 17Ad-15. GUARANTEES BY A NOTARY PUBLIC ARE NOT ACCEPTABLE. SIGNATURE GUARANTEES MUST NOT BE DATED.