Exhibit 4.2


 


THIS
WARRANT AND THE SHARES OF COMMON STOCK ISSUABLE UPON EXERCISE OF THIS WARRANT
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR ANY
STATE SECURITIES LAWS. THIS WARRANT AND THE COMMON STOCK ISSUABLE UPON EXERCISE
OF THIS WARRANT MAY NOT BE SOLD, OFFERED FOR SALE, PLEDGED OR HYPOTHECATED
IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT AS TO THIS WARRANT UNDER
SAID ACT AND ANY APPLICABLE STATE SECURITIES LAWS OR AN OPINION OF COUNSEL
REASONABLY SATISFACTORY TO GEOPETRO RESOURCES COMPANY THAT SUCH REGISTRATION IS
NOT REQUIRED.


 


Right to Purchase up to                 Shares
of Common Stock of


 


GEOPETRO RESOURCES COMPANY


 


(subject to adjustment as provided herein)


 


COMMON STOCK PURCHASE WARRANT


 


Issue Date:                             ,
2010


 


VOID AFTER 5:00 P.M. LOCAL TIME,                      ,
2013


 


GEOPETRO
RESOURCES COMPANY, a corporation organized under the laws of the State of
California (the “Corporation”), hereby certifies that, for value
received,                                           or
assigns (the “Holder”), is entitled, subject to the terms set forth
below, to purchase from the Corporation (as defined herein) from and after the
Issue Date of this Common Stock Purchase Warrant (“Warrant”) and at any
time or from time to time before 5:00 p.m. local time through the close of
business on
                              ,
2013 (the “Expiration Date”), up to
                              
[50% OF NUMBER OF COMMON SHARES PURCHASED]  fully paid and nonassessable shares of Common
Stock (as hereinafter defined), at the applicable Exercise Price (as defined
below) per share. The number and character of such shares of Common Stock and
the applicable Exercise Price per share are subject to adjustment as provided herein.


 


As
used herein the following terms, unless the context otherwise requires, have
the following respective meanings:


 


(a)           The term “Common Stock” includes (i) the
Corporation’s Common Stock; and (ii) any other securities into which or
for which any of the securities described in the preceding clause (i) may
be converted or exchanged pursuant to a plan of recapitalization,
reorganization, merger, sale of assets or otherwise.


 


(b)           The term “Corporation” includes GeoPetro
Resources Company and any business entity which shall succeed, or assume the
obligations of, GeoPetro Resources Company hereunder.


 


1

















 


(c)           The “Exercise Price” applicable under this
Warrant shall be $0.75 per Common Share (subject to adjustment pursuant to Section 4).


 


(d)           The term “Other Securities” refers to any
stock (other than Common Stock) and other securities of the Corporation or any
other person (corporate or otherwise) which the holder of the Warrant at any
time shall be entitled to receive, or shall have received, on the exercise of
the Warrant, in lieu of or in addition to Common Stock, or which at any time
shall be issuable or shall have been issued in exchange for or in replacement
of Common Stock or Other Securities pursuant to Section 4 or
otherwise.


 


(e)           The term “Subscription Agreement” means the
Unit Subscription Agreement between the Corporation and the Holder, accepted by
the Corporation on
                              ,
2010.


 


All
other defined terms have the meaning attributed to them in the Subscription
Agreement.


 


1.             Exercise of Warrant.


 


1.1           Number of
Shares Issuable upon Exercise. From and after the date
hereof through and including the Expiration Date, the Holder shall be entitled
to receive, upon exercise of this Warrant in whole or in part, by delivery to
the Corporation of this Warrant Certificate, an original copy of an exercise
notice in the form attached hereto as Exhibit A (the “Subscription
Form”) duly completed and executed and the satisfaction of the surrender
and payment requirements of Section 2, the number of shares of
Common Stock of the Corporation set forth in the Subscription Form, subject to
adjustment pursuant to Section 5.


 


1.2           Corporation
Acknowledgment. The Corporation will, at the time of the exercise
of the Warrant, upon the request of the Holder acknowledge in writing its
continuing obligation to afford to such Holder any rights to which such Holder
shall continue to be entitled after such exercise in accordance with the
provisions of this Warrant. If the Holder shall fail to make any such request,
such failure shall not affect the continuing obligation of the Corporation to
afford to such Holder any such rights.


 


1.3           Legends.


 


(a)           Each certificate for Common
Stock issued upon exercise of this Warrant shall bear the following legend:


 


“THE SECURITIES REPRESENTED HEREBY HAVE NOT BEEN
REGISTERED UNDER THE UNITED STATES SECURITIES ACT OF 1933, AS AMENDED (THE
“SECURITIES ACT”). THESE SECURITIES MAY BE OFFERED, SOLD, PLEDGED OR
OTHERWISE TRANSFERRED ONLY (A) TO THE CORPORATION, (B) OUTSIDE THE
UNITED STATES IN COMPLIANCE WITH RULE 904 OF REGULATION S UNDER THE
SECURITIES ACT, (C) IN COMPLIANCE WITH RULE 144 OR 144A THEREUNDER, IF
AVAILABLE, AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS, (D) PURSUANT
TO AN 


 


2

















 


EFFECTIVE REGISTRATION STATEMENT, OR (E) IN A
TRANSACTION THAT DOES NOT REQUIRE REGISTRATION UNDER THE SECURITIES ACT OR ANY
APPLICABLE STATE SECURITIES LAWS, AND THE HOLDER HAS, PRIOR TO SUCH SALE,
FURNISHED TO THE CORPORATION AN OPINION OF COUNSEL OR OTHER EVIDENCE OF
EXEMPTION, IN EITHER CASE REASONABLY SATISFACTORY TO THE CORPORATION.
HEDGING TRANSACTIONS INVOLVING THESE SECURITIES MAY NOT BE CONDUCTED
UNLESS IN COMPLIANCE WITH THE U.S. SECURITIES ACT.”


 


2.             Procedure for Exercise.


 


2.1           Delivery of
Stock Certificates, Etc., on Exercise. The Corporation agrees
that the shares of Common Stock purchased upon exercise of this Warrant shall
be deemed to be issued to the Holder as the owner of record of such shares as
of the close of business on the date on which the duly completed and executed
Subscription Form, this Warrant Certificate and payment for such shares shall
have been received by the Corporation in accordance herewith. As soon as
practicable after the exercise of this Warrant in full or in part, and in any
event within seven (7) business days thereafter, the Corporation at the
Corporation’s expense (including the payment by it of any applicable issue
taxes) will cause to be issued in the name of and delivered to the Holder, or
as such Holder (upon payment by such Holder of any applicable transfer taxes)
may direct in compliance with applicable securities laws, a certificate or
certificates for the number of duly and validly issued, fully paid and
nonassessable shares of Common Stock (or Other Securities) to which such Holder
shall be entitled on such exercise. By acceptance hereof, the Holder expressly
waives any right to receive fractional Common Shares upon exercise of this Warrant.
If the number of Common Shares to which the Holder would otherwise be entitled
upon the exercise of this Warrant Certificate is not a whole number, then the
number of Common Shares to be issued will be rounded down to the next whole
number. Following a partial exercise of this Warrant prior to the Expiration
Date, the Corporation shall cancel this Warrant Certificate and, within five
business days, execute and deliver to the Holder a new Warrant Certificate of
like tenor covering the remaining balance of the shares of Common Stock subject
to this Warrant Certificate.


 


2.2           Exercise. Payment may
be made by certified or official bank check payable to the order of the
Corporation equal to the applicable aggregate Exercise Price, for the number of
Common Shares specified in such Subscription Form (as such exercise number
shall be adjusted to reflect any adjustment in the total number of shares of
Common Stock issuable to the Holder in accordance with the terms of this
Warrant) and the Holder shall thereupon be entitled to receive the number of
duly authorized, validly issued, fully-paid and non-assessable shares of Common
Stock (or Other Securities) determined as provided herein.


 


2.3           Representation. The Holder of
this Warrant has represented to the Corporation that it is acquiring this
Warrant for its own account and not with a view toward, or for resale in
connection with, the public sale or distribution of this Warrant or the
underlying shares of Common Stock, except pursuant to sales registered or
exempted under the Securities Act of 1933, as amended (the “Securities Act”).
The Holder of this Warrant further represented that as of the Issue Date, the
Holder was an “accredited investor” as that term is defined in 


 


3

















 


Rule 501(a)(3) of Regulation D promulgated
by the Securities and Exchange Commission under the Securities Act.  In order to exercise this Warrant, the
representations concerning the Holder and the shares of Common Stock underlying
this Warrant contained in the first two sentences of this Section 2.3
must be true and correct as of such time, and therefore the Holder shall, if
requested by the Corporation, confirm the foregoing to the satisfaction of the
Corporation.


 


3.             Effect of Reorganization, Etc.; Adjustment of Exercise Price.


 


3.1           Reorganization,
Consolidation, Merger, Etc. If at any time or from
time to time, the Corporation (a) effects a reorganization, (b) consolidates
with or merges into any other person, or (c) transfers all or
substantially all of its properties or assets to any other person under any
plan or arrangement contemplating the dissolution of the Corporation, then, in
each such case, as a condition to the consummation of such a transaction,
proper and adequate provision shall be made by the Corporation whereby the
Holder of this Warrant, on the exercise hereof as provided in Section 1
at any time after the consummation of such reorganization, consolidation or
merger or the effective date of such dissolution, as the case may be, shall
receive, in lieu of the Common Stock (or Other Securities) issuable on such
exercise prior to such consummation or such effective date, the stock and other
securities and property (including cash) to which such Holder would have been
entitled upon such consummation or in connection with such dissolution, as the
case may be, if such Holder had so exercised this Warrant, immediately prior
thereto, all subject to further adjustment thereafter as provided in Section 4.


 


3.2           Dissolution. In the event
of any dissolution of the Corporation following the transfer of all or
substantially all of its properties or assets, the Corporation, concurrently
with any distributions made to holders of its Common Stock, shall at its
expense deliver or cause to be delivered to the Holder the stock and other
securities and property (including cash, where applicable) receivable by the
Holder of this Warrant pursuant to Section 3.1, or if the Holder
also instructs the Corporation, to a bank or trust company specified by the
Holder as trustee for the Holder (the “Trustee”).


 


3.3           Continuation
of Terms. Upon any reorganization, consolidation, merger or
transfer (and any dissolution following any transfer) referred to in this Section 3,
this Warrant shall continue in full force and effect and the terms hereof shall
be applicable to the shares of stock and other securities and property
receivable on the exercise of this Warrant after the consummation of such
reorganization, consolidation or merger or the effective date of dissolution following
any such transfer, as the case may be, and shall be binding upon the issuer of
any such stock or other securities, including, in the case of any such
transfer, the person acquiring all or substantially all of the properties or
assets of the Corporation, whether or not such person shall have expressly
assumed the terms of this Warrant as provided in Section 4. If this
Warrant does not continue in full force and effect after the consummation of
the transactions described in this Section 3, then the Corporation’s
securities and property (including cash, where applicable) receivable by the
Holder of this Warrant will be delivered to the Holder or the Trustee as
contemplated by Section 3.2.


 


4.             Extraordinary Events Regarding Common Stock. If the
Corporation (a) issues additional shares of the Common Stock as a dividend
or other distribution on outstanding Common Stock or any preferred stock issued
by the Corporation, (b) subdivides its outstanding 


 


4

















 


shares of Common Stock, or (c) combines its
outstanding shares of the Common Stock into a smaller number of shares of the
Common Stock, then, in each such event, the Exercise Price shall,
simultaneously with the happening of such event, be adjusted by multiplying the
then Exercise Price by a fraction, the numerator of which shall be the number
of shares of Common Stock outstanding immediately prior to such event and the
denominator of which shall be the number of shares of Common Stock outstanding
immediately after such event, and the product so obtained shall thereafter be
the Exercise Price then in effect. The Exercise Price, as so adjusted, shall be
readjusted in the same manner upon the happening of any successive event or
events described herein in this Section 4. The number of shares of
Common Stock that the Holder of this Warrant shall thereafter, on the exercise
hereof as provided herein in Section 1, be entitled to receive
shall be adjusted to a number determined by multiplying the number of shares of
Common Stock that would otherwise (but for the provisions of this Section 4)
be issuable on such exercise by a fraction of which (a) the numerator is
the Exercise Price that would otherwise (but for the provisions of this Section 4)
be in effect, and (b) the denominator is the Exercise Price in effect on
the date of such exercise.


 


5.             Certificate as to Adjustments. In each case of any
adjustment or readjustment in the shares of Common Stock (or Other Securities)
issuable on the exercise of the Warrant as provided for in Section 3 or
4 above, the Corporation at its expense will promptly cause its Chief
Financial Officer or other appropriate designee to compute such adjustment or
readjustment in accordance with the terms of the Warrant and prepare a
certificate setting forth such adjustment or readjustment and showing in detail
the facts upon which such adjustment or readjustment is based, including a
statement of (a) the consideration received or receivable by the
Corporation for any additional shares of Common Stock (or Other Securities)
issued or sold or deemed to have been issued or sold, (b) the number of
shares of Common Stock (or Other Securities) outstanding or deemed to be
outstanding, and (c) the Exercise Price and the number of shares of Common
Stock to be received upon exercise of this Warrant, in effect immediately prior
to such adjustment or readjustment and as adjusted or readjusted as provided in
this Warrant. The Corporation will forthwith mail or cause to be mailed a copy
of each such certificate to the Holder of this Warrant.


 


6.             Reservation of Stock, Etc. Issuable on Exercise of Warrant. The
Corporation will at all times reserve and keep available, solely for issuance
and delivery on the exercise of the Warrant, shares of Common Stock (or Other
Securities) from time to time issuable on the exercise of the Warrant.


 


7.             Assignment; Exchange of Warrant. Subject to compliance with
applicable securities laws, this Warrant, and the rights evidenced hereby, may
be transferred by any registered holder hereof (a “Transferor”) in whole
or in part. On the surrender for exchange of this Warrant, with the
Transferor’s endorsement in the form of Exhibit B (the “Transferor
Endorsement Form”), together with evidence reasonably satisfactory to the
Corporation demonstrating compliance with applicable securities laws (which
shall include, without limitation, the provision of a legal opinion from the
Transferor’s counsel that such transfer is exempt from the registration or
equivalent requirements of applicable securities laws) the Corporation at the
Corporation’s expense (but with payment by the Transferor of any applicable
transfer taxes), and written confirmation by the Corporation of receipt of
satisfactory evidence and to proceed with transfer with legend instructions,
will issue and deliver to or on the order of the Transferor thereof a new 


 


5

















 


Warrant of like tenor, in the name of the Transferor
and/or the transferee(s) specified in such Transferor Endorsement Form (each
a “Transferee”), calling in the aggregate on the face or faces thereof
for the number of shares of Common Stock called for on the face or faces of the
Warrant so surrendered by the Transferor.


 


8.             Replacement of Warrant. On receipt of evidence
reasonably satisfactory to the Corporation of the loss, theft, destruction or
mutilation of this Warrant and, in the case of any such loss, theft or
destruction of this Warrant, on delivery of an indemnity agreement and surety
bond reasonably satisfactory in form and amount to the Corporation, the
Corporation at the Holder’s expense and Holder’s payment of charges of the
Corporation, will execute and deliver, in lieu thereof, a new Warrant of like
tenor.


 


9.             Exercise Restrictions.


 


9.1           Beneficial
Ownership Limitation.
Notwithstanding anything contained herein to the contrary, the Holder may not
exercise this Warrant to the extent such exercise would result in the Holder,
together with any affiliate thereof, beneficially owning a number of shares of
Common Stock in excess of 4.99% of the then issued and outstanding shares of
Common Stock of the Corporation. For the purposes of the immediately preceding
sentence, beneficial ownership shall be determined in accordance with
Section 13(d) of the Securities Exchange Act of 1934 (the “Exchange
Act”) and Rule 13d-3 thereunder. Since the Holder will not be
obligated to report to the Corporation the number of shares of Common Stock it
may hold at the time of an exercise hereunder, unless the exercise at issue
would result in the issuance of shares of Common Stock in excess of 4.99% of
the then outstanding shares of Common Stock without regard to any other shares
which may be beneficially owned by the Holder or an affiliate thereof, the
Holder shall have the authority and obligation to determine whether the
restriction contained in this Section 9 will limit any particular
exercise hereunder and to the extent that the Holder determines that the
limitation contained in this Section 9 applies, the determination
of the amount of this Warrant that is exercisable shall be the responsibility
and obligation of the Holder. The provisions of this Section 9.1
may be waived by the Holder (but only as to itself and not to any other holder
of Warrants) in whole or in part upon not less than 61 days’ prior notice to
the Corporation. Other holders of Warrants shall be unaffected by any such
waiver.


 


9.2           Limitation
on Number of Shares Issuable.
Notwithstanding anything contained herein to the contrary, the rights
represented by this Warrant shall not be exercisable by the Holder, in whole or
in part, and the Corporation shall not give effect to any such exercise, if,
after giving effect to such exercise, the Holder, together with any person or
company acting jointly or in concert with the Holder (the “Joint Actors”)
would in the aggregate beneficially own or exercise control or direction over
that number of voting securities of the Corporation which is 19.99% or greater
of the total issued and outstanding voting securities of the Corporation. For
greater certainty, the rights represented by this Warrant shall not be
exercisable by the Holder, in whole or in part, and the Corporation shall not
give effect to any such exercise, if, after giving effect to such exercise, the
Holder, together with its Joint Actors, would be deemed to hold a number of
voting securities sufficient to materially affect the control of the
Corporation.


 


9.3           Provision
of Officer’s Certificate. Prior to
exercising the rights represented by this Warrant, the Holder shall provide the
Corporation with a certificate stating the number of 


 


6

















 


voting securities of the Corporation held by the
Holder and its Joint Actors as of the date provided for in the exercise notice
(the “Certificate”) and the Corporation shall be entitled to rely on the
Certificate in making any determinations regarding the total issued and
outstanding voting securities of the Corporation to be held by the Holder and
its Joint Actors after giving effect to the exercise. The execution of the
Subscription Form by the Holder will suffice as the Holder’s
acknowledgement of compliance with such exercise limits as set forth in this Section 9.


 


10.           Transfer on the
Corporation’s Books. Until this Warrant is transferred on the
books of the Corporation, the Corporation may treat the registered Holder
hereof as the absolute owner hereof for all purposes, notwithstanding any
notice to the contrary.


 


11.           Notices, Etc. All notices
and other communications from the Corporation to the Holder of this Warrant
shall be delivered by ordinary surface or air mail, postage prepaid, addressed
to the Holder or delivered at their respective address appearing on the
register of Holders.


 


12.           Miscellaneous.
Notwithstanding any provision to the contrary contained in this Warrant, no
Common Stock will be issued pursuant to the exercise of this Warrant if the
issuance of such securities may constitute a violation of the securities laws
of any applicable jurisdiction. This Warrant and any term hereof may be changed,
waived, discharged or terminated only by an instrument in writing signed by the
party against which enforcement of such change, waiver, discharge or
termination is sought. THIS WARRANT SHALL BE GOVERNED BY AND CONSTRUED IN
ACCORDANCE WITH THE LAWS OF STATE OF CALIFORNIA WITHOUT REGARD TO PRINCIPLES OF
CONFLICTS OF LAWS. ANY ACTION BROUGHT CONCERNING THE TRANSACTIONS CONTEMPLATED
BY THIS WARRANT SHALL BE BROUGHT ONLY IN THE STATE COURTS OF CALIFORNIA OR IN
THE FEDERAL COURTS LOCATED IN THE STATE OF CALIFORNIA. The Holder and the
Corporation shall submit to the jurisdiction of such courts and waive trial by
jury. The prevailing party shall be entitled to recover from the other party
its reasonable attorney’s fees and costs. If any provision of this Warrant is
invalid or unenforceable under any applicable statute or rule of law, then
such provision shall be deemed inoperative to the extent that it may conflict
therewith and shall be deemed modified to conform with such statute or rule of
law. Any such provision which may prove invalid or unenforceable under any law
shall not affect the validity or enforceability of any other provision of this
Warrant. The headings in this Warrant are for purposes of reference only, and
shall not limit or otherwise affect any of the terms hereof. The invalidity or
unenforceability of any provision hereof shall in no way affect the validity or
enforceability of any other provision hereof.


 


IN
WITNESS WHEREOF, the Corporation has executed this Warrant as of the date first
written above.


 


	
   

  	
  GEOPETRO
  RESOURCES COMPANY

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
   

  
	
   

  	
  Its:

  	
   

  



 


7
















 


EXHIBIT A


 


FORM OF SUBSCRIPTION


(To Be Signed Only On Exercise of Warrant)


 


TO:                            GeoPetro
Resources Company


150
California Street, Suite 600


San
Francisco, California 94111


Attention:          President


 


The
undersigned, pursuant to the provisions set forth in the attached Warrant,
hereby irrevocably elects to purchase:


 


________
shares of the Common Stock covered by such Warrant


 


The
undersigned herewith makes payment of the full Exercise Price for such shares
at the price per share provided for in such Warrant, which is $0.75.  Such payment takes the form of:


 


________
certified
check                                     ________
bank draft


 


The
undersigned requests that the certificates for such shares be issued in the
name of, and delivered to
                                                                                            
whose address is                                                                                                                                                                                                                        
                                                                                                                                                                                                                      
                                     .


 


(Please
print full name in which share certificates are to be issued. If any shares are
to be issued to a person or persons other than the Warrantholder, the
Warrantholder must pay all applicable transfer taxes or other government
charges.)


 


Terms
not defined herein shall have the same meanings ascribed to them in the Warrant
Certificate.


 


The
undersigned represents and warrants that all offers and sales by the
undersigned of the securities issuable upon exercise of the within Warrant
shall be made in reliance upon available exemptions from the prospectus and
registration or equivalent requirements of applicable securities legislation.


 


 


	
  Dated:

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  (Signature
  must conform to name of holder as specified on the face of the Warrant)

  



 


A-1

















 


	
   

  	
   

  	
  Name:

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Address:

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Signature
  Guaranteed By:

  



 


The
signature of the Holder to this Form must correspond exactly with the name
of the Holder as set forth on the face of this Warrant Certificate in every
particular, without alteration or enlargement or any change whatsoever and the
signature must be guaranteed by a chartered bank or by a trust company or by a
medallion signature guarantee from a member of a recognized Signature Medallion
Guarantee Program.


 


A-2

















 


EXHIBIT B


 


FORM OF TRANSFEROR ENDORSEMENT


(To Be Signed Only On Transfer of Warrant)


 


For
value received, the undersigned hereby sells, assigns, and transfers unto the
person(s) named below under the heading “Transferees” the right
represented by the within Warrant to purchase shares of Common Stock of
GeoPetro Resources Company into which the within Warrant relates specified
under the headings “Number of Warrants Transferred,” respectively, opposite the
name(s) of such person(s) and appoints                                   the
attorney to transfer its respective right on the register of warrants
maintained by the Corporation with full power of substitution in the premises.


 


	
  Transferees

  	
   

  	
  Address

  	
   

  	
  Number of Warrants

  Transferred

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  



 


	
  Dated:

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  (Signature
  must conform to name of holder as specified on the face of the Warrant)

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Address:

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Signature
  Guarantee

  
	
   

  	
   

  	
   

  	
   

  
	
  ACCEPTED AND AGREED:

  	
   

  	
   

  
	
  [TRANSFEREE]

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  (Name)

  	
   

  	
   

  



 


B-1

















 


The
signature of the Holder to this Form must correspond exactly with the name
of the Holder as set forth on the face of this Warrant Certificate in every
particular, without alteration or enlargement or any change whatsoever and the
signature must be guaranteed by a chartered bank or by a trust company or by a
medallion signature guarantee from a member of a recognized Signature Medallion
Guarantee Program.


 


B-2