ex4_17.htm


 EXHIBIT 4.17




 


 



	
 NUMBER 

		
 SHARES 







 










	
 INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE 


 


 AUTHORIZED:  2,300,000 SHARES OF SERIES B CONVERTIBLE PREFERRED STOCK, 


 $0.01 PAR VALUE PER SHARE 







 







	    	    	
 CUSIP [     ] 


 SEE REVERSE FOR 


 CERTAIN DEFINITIONS 







 


 THIS CERTIFIES that 


 


 SPECIMEN 


 


 is the owner of 


 


 Fully Paid and Non-Assessable Shares of Series B Convertible Preferred Stock, $0.01 Par Value of 







 SKYLINE MEDICAL INC. 


 


 transferable on the books of the Corporation in person or by attorney upon surrender of this Certificate duly endorsed or assigned.  This Certificate and the shares represented hereby are subject to the Certificate of Incorporation and the Bylaws of the Corporation and the Certificate of Designation relating thereto approved by the Board of Directors of the Corporation, as now or hereafter amended, copies of which are on file with the Company and the Transfer Agent, to all of which the holder by acceptance hereof assents.  This Certificate is not valid until countersigned by the Transfer Agent. 


 


 IN WITNESS WHEREOF, the Corporation has caused this Certificate to be signed by the facsimile signatures of its duly authorized officers and to be sealed with the facsimile seal of the Corporation. 


 


 Dated: 


 








	   	    	    	
 [SEAL] 

	    	    	   
	   	
 President 

	   	   	   	
 Secretary 

	   





 


 Countersigned: 


 CORPORATE STOCK TRANSFER, INC. 


 3200 Cherry Creek South Drive, Suite 430 


 Denver, CO  80209 


 



	
 BY 

	    	   
	
 Transfer Agent and Registrar Authorized Officer 

	   





 


 THE CORPORATION WILL 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. 


 




    





    











    







 SKYLINE MEDICAL INC. 


 CORPORATE STOCK TRANSFER, INC. 


 TRANSFER FEE:  AS REQUIRED 




 


 


 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. 


 


	    







 PLEASE INSERT SOCIAL SECURITY OR OTHER 


       IDENTIFYING NUMBER OF ASSIGNEE      


 



	   





 




	
 FOR VALUE RECEIVED, ____________________________ hereby sell, assign and transfer unto 


 


	
 PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS INCLUDING POSTAL ZIP CODE OF ASSIGNEE 


 


 


	
    


 


	
    


 









 


 _______________________________________________________________________________________ Shares of the Series B Convertible Preferred 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: _______________________, 20____. 



	    	    	   	    
	    	
 Signature: 

	
 X 

	
 


	
 Signature(s) Guaranteed: 

	    	   	    
	    	
 Signature: 

	
 X 

	
 







 


 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 WHATEVER.  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.