Form of Common Stock Certificate



 Exhibit 4.1 

 

	
	





 016570| 003590|127C|RESTRICTED||4|057-423 

COMMON STOCK 
 PAR VALUE $0.0001 
 COMMON STOCK 

THIS CERTIFICATE IS TRANSFERABLE IN CANTON, MA AND NEW YORK, NY 

SAMPLE 
 Certificate Number 
 ZQ 000000 

Shares 
 * * 0 0 0 0 0 0 * * * * * * 
 * * * 0 0 0 0 0 0 * *
* * * 
 * * * * 0 0 0 0 0 0 * * * * 
 * * * * * 0 0 0 0 0 0 * * * 
 * * * * * * 0 0 0 0 0
0 * * 
 TEAVANA HOLDINGS, INC. 
 INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE 
 THIS CERTIFIES THAT 
 ** Mr. Alexander David Sample
**** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David
Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample MR **** Mr. Alexander . SAMPLE David Sample ****
Mr. Alexander David &Sample MRS **** Mr. Alexander . David SAMPLE Sample **** Mr. Alexander David & Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample ****
Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David
Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander MR David . Sample SAMPLE **** Mr. Alexander David Sample & **** Mr . Alexander MRS David Sample . **** SAMPLE Mr. Alexander
David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr.
Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Sample **** Mr. Sample

 CUSIP XXXXXX XX X 
 SEE REVERSE FOR CERTAIN DEFINITIONS 
 is the owner
of 

**000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares***
 *000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****
000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****0
00000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****00 ***ZERO HUNDRED THOUSAND
0000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000
000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****0000
00**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****00000
0**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000
**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000* ZERO HUNDRED AND ZERO***
*Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**
Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**S 
 FULLY-PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK OF 
 Teavana Holdings, Inc. (hereinafter called the “Company”), transferable on the books of the Company in person or by duly authorized attorney, upon surrender of this Certificate
properly endorsed. This Certificate and the shares represented hereby, are issued and shall be held subject to all of the provisions of the Certificate of Incorporation, as amended, and the By-Laws, as amended, of the Company (copies of which are on
file with the Company and with the Transfer Agent), to all of which each holder, by acceptance hereof, assents. This Certificate is not valid unless countersigned and registered by the Transfer Agent and Registrar. 

Witness the facsimile seal of the Company and the facsimile signatures of its duly authorized officers. 

DATED > 
 COUNTERSIGNED AND REGISTERED: 
 COMPUTERSHARE TRUST
COMPANY, N.A. 
 TRANSFER AGENT AND REGISTRAR, 

Executive Vice President and Chief Financial Officer 

Chief Executive Officer 
 By 
 AUTHORIZED SIGNATURE 

Teavana Holdings, Inc. 
 SEAL 
 DELAWARE 

2004 
 Teavana Holdings, Inc. 
 PO BOX 43004, Providence,
RI 02940-3004 
 MR A SAMPLE DESIGNATION (IF ANY) ADD 1 ADD 2 ADD 3 ADD 4 

CUSIP XXXXXX XX X Holder ID XXXXXXXXXX 
 Insurance Value 00.1,000,000 Number of Shares 123456 
 DTC 12345678901234512345678 
 Certificate Numbers
Num/No Denom. Total. 
 1234567890/1234567890 111 1234567890/1234567890 222 1234567890/1234567890 333
1234567890/1234567890 444 1234567890/1234567890 555 1234567890/1234567890 666 
 Total Transaction 7 







 



 
 TEAVANA HOLDINGS, INC. 

THE COMPANY WILL FURNISH WITHOUT CHARGE TO EACH SHAREHOLDER WHO SO REQUESTS, A SUMMARY OF THE POWERS, DESIGNATIONS,
PREFERENCES AND RELATIVE, PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OF THE COMPANY AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND RIGHTS, AND THE VARIATIONS IN RIGHTS, PREFERENCES AND
LIMITATIONS DETERMINED FOR EACH SERIES, WHICH ARE FIXED BY THE CERTIFICATE OF INCORPORATION OF THE COMPANY, AS AMENDED, AND THE RESOLUTIONS OF THE BOARD OF DIRECTORS OF THE COMPANY, AND THE AUTHORITY OF THE BOARD OF DIRECTORS TO DETERMINE VARIATIONS
FOR FUTURE SERIES. SUCH REQUEST MAY BE MADE TO THE OFFICE OF THE SECRETARY OF THE COMPANY OR TO THE TRANSFER AGENT. THE BOARD OF DIRECTORS MAY REQUIRE THE OWNER OF A LOST OR DESTROYED STOCK CERTIFICATE, OR HIS LEGAL REPRESENTATIVES, TO GIVE THE
COMPANY A BOND TO INDEMNIFY IT AND ITS TRANSFER AGENTS AND REGISTRARS AGAINST ANY CLAIM THAT MAY BE MADE AGAINST THEM ON ACCOUNT OF THE ALLEGED LOSS OR DESTRUCTION OF ANY SUCH 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: 
 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 Act 

(State) 
 JT TEN - as joint tenants with right of survivorship UNIF TRF MIN ACT -............................................Custodian (until age ................................) and not as tenants
in common (Cust) .............................under Uniform Transfers to Minors Act 
 (Minor) (State)

 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, INCLUDING POSTAL ZIP CODE,
OF ASSIGNEE) 
 Shares of the comon stock represented by the within Certificate, and do hereby irrevocably
constitute and appoint _______________________________________________________________________________________________________________________ Attorney to transfer the said stock on the books of the within-named Company with full power of
substitution in the premises. 
 Dated: __________________________________________20__________________

 Signature: ____________________________________________________________ 

Signature: ____________________________________________________________ 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. 
 THE SIGNATURE(S) Signature(s) SHOULD BE Guaranteed: GUARANTEED BY Medallion AN ELIGIBLE Guarantee GUARANTOR Stamp INSTITUTION (Banks, Stockbrokers, SIGNATURE GUARANTEE Savings and Loan
MEDALLION Associations PROGRAM, and Credit PURSUANT Unions) WITH TO S. E. MEMBERSHIP C. RULE 17Ad-15. IN AN APPROVED 
 The IRS requires that we report the cost basis of certain shares acquired after January 1, 2011. If your shares were covered by the legislation and you have sold or transferred the shares
and requested a specific cost basis calculation method, we have processed as requested. If you did not specify 

a cost basis calculation method, we have defaulted to the first in, first out (FIFO) method. Please visit our website or
consult your tax advisor if you need additional information about cost basis. 
 If you do not keep in contact
with us or do not have any activity in your account for the time periods specified by state law, your property could become subject to state unclaimed property laws and transferred to the appropriate state. 

1234567 
 SECURITY INSTRUCTIONS 
 THIS IS WATERMARKED PAPER
DO NOT ACCEPT WITHOUT NOTING WATERMARK. HOLD TO LIGHT OT VERIFY WATERMARK.