EX-4.1 4 dex41.txt FORM OF SPECIMEN CERTIFICATE OF COMMON STOCK Exhibit 4.1 Number LU- COMMON STOCK SHARES ----------------------- AMERIGON ----------------------- --------------------------------------------- SEE REVERSE FOR CERTAIN INCORPORATED UNDER THE LAWS OF THE STATE OF DEFINITIONS CALIFORNIA CUSIP 03070L 30 0 This Certifies that is the recordholder of FULLY PAID AND NON ASSESSABLE SHARES OF THE COMMON STOCK, WITHOUT PAR VALUE, OF Amerigon Incorporated, transferable only on the books of the Corporation by the Holder hereof in person or by duly authorized attorney upon surrender of this certificate properly endorsed. This certificate is not valid unless countersigned and registered by the Transfer Agent and Registrar. Witness the Facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers. Dated /s/ Sandra L. Grouf [SEAL] /s/ O. B. Marx III SECRETARY CHIEF EXECUTIVE OFFICER Countersigned and registered: U.S. Stock Transfer Corporation (Glendale, CA) Transfer Agent and Registrar By: Authorized Signature A statement of the rights, preferences and restrictions granted to or imposed upon each class of shares authorized to be issued and upon the holders thereof may be obtained by shareholders, upon request and without charge, from the Corporation at its principal executive office or from the Transfer Agent. 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 JT TEN - as joint tenants with right Act____________________________ of survivorship and not as (State) tenants in common COM PROP - as community property UNIF TRF MIN ACT - ____ Custodian (until age ____) (Cust) _______ under Uniform Transfers (Minor) to Minors Act__________________ (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 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 _______________________________ ______________________________________________________________________________ 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.
Signature(s) Guaranteed: By THE SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION. (BANKS, STOCK BROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM). PURSUANT TO S.E.C. RULE 17 Ad-15.