Exhibit 4.1




	
  

  	
  S1 Biopharma, Inc.

  CUSIP 835428 10 3

  $0.000

  American stock
  transfer & trust company, LLC

   

  






 


 








 

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
    	
 
    
	
TEN   ENT
    	
—   
    	
as   tenants by the entireties
    	
 
    	
 
    	
(Cust)
    	
 
    	
(Minor)
    
	
JT   TEN 
    	
—   
    	
as   joint tenants with right of survivorship and not as tenants in common
    	
 
    	
 
    	
under   Uniform Gifts 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 TYPE NAME AND ADDRESS, INCLUDING ZIP CODE, OF ASSIGNEE

 

 

                                                                                                                                                                                                          Shares of the common 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 Corporation with full power of substitution in the premises. 

 

	
Dated
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
X
    	
 
    
	
 
    	
X
    	
 
    
	
 
    	
NOTICE:
    	
THE   SIGNATURE(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN   UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR   ENLARGEMENT OR ANY CHANGE WHATSOEVER.
    
	
 
    	
 
    	
 
    
	
Signature(s) Guaranteed
    	
 
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    
	
By
    	
 
    	
 
    	
 
    	
 
    
	
THE   SIGNATURE(S) MUST 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.
    	
 
    	
 
    	
 
    
						


 


	
ABnote North America
    	
 
    	
 
    
	
711 ARMSTRONG LANE
    	
 
    	
PROOF OF: OCTOBER 21, 2014
    
	
COLUMBIA, TENNESSEE 38401
    	
 
    	
S1 BIOPHARMA, INC.
    
	
(931) 388-3003
    	
 
    	
WO- 9170 BACK
    
	
HOLLY GRONER 931-490-7660
    	
 
    	
OPERATOR: MV
    
	
 
    	
 
    	
NEW
    




 

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