EX-4.5



 Exhibit 4.5 
  






 
 THIS CERTIFIES THAT 
is
the owner of 
CUSIP 
DATED 
COUNTERSIGNED AND REGISTERED: 
COMPUTERSHARE TRUST COMPANY, N.A. 
TRANSFER AGENT AND REGISTRAR, 
FULLY-PAID AND NON-ASSESSABLE SHARES OF THE SERIES A-1 PREFERRED
STOCK OF 
The Providence Service Corporation (hereinafter called the “Company”), transferable on the books of the Company in person or by duly authorized
attorney or legal representative, 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. 
SERIES A-1 PREFERRED STOCK 
PAR VALUE $0.001 
SERIES A-1 PREFERRED STOCK 
THIS CERTIFICATE IS TRANSFERABLE 
IN CANTON, MA, JERSEY CITY, NJ AND 
COLLEGE STATION, TX 
SEE REVERSE FOR CERTAIN DEFINITIONS 
Certificate 
Number 
Shares 
THE PROVIDENCE SERVICE CORPORATION 
INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE

By 
AUTHORIZED SIGNATURE 
XXXXXX XX X 
THE PROVIDENCE SERVICE CORPORATION 
ZQ|CERT#|COY|CLS|RGSTRY|ACCT#|TRANSTYPE|RUN#|TRANS# 
DD-MMM-YYYY 
* * 000000* * * * * * * * * * * * * * * * * * 
* * * 000000* * * * * * * * * * * * * * * * *

* * * * 000000* * * * * * * * * * * * * * * * 
* * * * * 000000* * * * * * * *
* * * * * * * 
* * * * * * 000000* * * * * * * * * * * * * * 
** 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
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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
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 David Sample **** Mr. Sample **** Mr. Sample

**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 
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* 
*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 
***ZERO HUNDRED THOUSAND 
ZERO HUNDRED AND ZERO*** 
MR. SAMPLE & MRS. SAMPLE & 
MR. SAMPLE & MRS. SAMPLE 
ZQ00000000 
Certificate Numbers 
1234567890/1234567890 
1234567890/1234567890 
1234567890/1234567890 
1234567890/1234567890 
1234567890/1234567890 
1234567890/1234567890 
Total Transaction 
Num/No. 
123456 
Denom. 
123456 
Total 
1234567 
MR A SAMPLE 
DESIGNATION (IF ANY) 
ADD 1 
ADD 2 
ADD 3 
ADD 4 
PO BOX 43004, Providence, RI 02940-3004 
CUSIP XXXXXX XX X 
Holder ID XXXXXXXXXX 
Insurance Value 1,000,000.00 
Number of Shares 123456 
DTC 12345678 123456789012345 







 



 
 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. 
For value received, hereby sell, assign and transfer
unto 
Shares 
Attorney 
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. 
PLEASE INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING NUMBER OF ASSIGNEE 
(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE, OF ASSIGNEE) 
of the Series A-1 Preferred stock represented by the within Certificate, and do hereby irrevocably constitute and appoint to transfer the said stock on the books of the
within-named Corporation with full power of substitution in the premises. 
THE PROVIDENCE SERVICE CORPORATION 
Signature(s) Guaranteed: Medallion Guarantee Stamp 
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. 
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.