No. --------- ---------, ---------, 19-.

The X. Y. Trust Company of --------- hereby certifies that it has received from L. M. certificate number --------- for --------- shares of --------- dollars each of the common stock of the G. H. Company, which certificate is deposited under and subject to the terms and conditions endorsed hereon, to which the holder hereof assents and agrees to be bound by receiving this certificate.

The interest represented by this certificate is transferable only on the books of said trustees in person or by attorney and the surrender of this certificate, under rules established by the trustees hereunder.

The X. Y. Trust Company, For A. B., By---------, Secretary.

C. D.,

E. F., Trustees.

See references under | 8840.