Form of Common Stock Certificate



 Exhibit 4.1 
 

 







 THE CORPORATION IS AUTHORIZED TO ISSUE MORE THAN ONE CLASS OF STOCK. THE CORPORATION WILL FURNISH WITHOUT
CHARGE TO EACH STOCKHOLDER WHO SO REQUESTS THE POWERS, DESIGNATIONS, PREFERENCES, AND RELATIVE, PARTICIPATING, OPTIONAL, OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OR SERIES THEREOF AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH
PREFERENCES AND/OR RIGHTS. 
 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
	 		  	under Uniform Gifts to Minors
		  	     survivorship and not as tenants
	 		  	Act                                      
      
		  	     in common
	 		  	 (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
  
	 		 	 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.

	 	 	 	 
	  
	 
	Please print or typewrite name and address, including postal 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
                     
  

					
		  		  	  


 Signature(s) Guaranteed: 
  

	
	  

	 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.



 KEEP THIS CERTIFICATE IN A SAFE PLACE, IF IT IS LOST, STOLEN, MUTILATED OR DESTROYED, THE CORPORATION MAY
REQUIRE A BOND OF INDEMNITY AS A CONDITION TO THE ISSUANCE OF A REPLACEMENT CERTIFICATE. 
 THIS CERTIFICATE ALSO EVIDENCES AND ENTITLES
THE HOLDER HEREOF TO CERTAIN RIGHTS AS SET FORTH IN THE RIGHTS AGREEMENT BETWEEN JACKSON HEWITT TAX SERVICE INC. (THE “COMPANY”) AND THE RIGHTS AGENT THEREUNDER (THE “RIGHTS AGENT”) DATED AS OF JUNE 24, 2004 (THE “RIGHTS
AGREEMENT”), THE TERMS OF WHICH ARE HEREBY INCORPORATED HEREIN BY REFERENCE AND A COPY OF WHICH IS ON FILE AT THE PRINCIPAL OFFICES OF THE COMPANY. UNDER CERTAIN CIRCUMSTANCES, AS SET FORTH IN THE RIGHTS AGREEMENT, SUCH RIGHTS WILL BE EVIDENCED
BY SEPARATE CERTIFICATES AND WILL NO LONGER BE EVIDENCED BY THIS CERTIFICATE. THE COMPANY WILL MAIL TO THE HOLDER OF THIS CERTIFICATE A COPY OF THE RIGHTS AGREEMENT, AS IN EFFECT ON THE DATE OF MAILING, WITHOUT CHARGE, PROMPTLY AFTER RECEIPT OF A
WRITTEN REQUEST THEREFOR. UNDER CERTAIN CIRCUMSTANCES SET FORTH IN THE RIGHTS AGREEMENT, RIGHTS ISSUED TO, OR HELD BY, ANY PERSON WHO IS, WAS OR BECOMES AN ACQUIRING PERSON OR ANY AFFILIATE OR ASSOCIATE THEREOF (AS SUCH TERMS ARE DEFINED IN THE
RIGHTS AGREEMENT), WHETHER CURRENTLY HELD BY OR ON BEHALF OF SUCH PERSON OR BY ANY SUBSEQUENT HOLDER, MAY BECOME NULL AND VOID.