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Number
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1st Source Corporation |
Shares
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INCORPORATED UNDER THE LAWS OF THE STATE OF INDIANA | |
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SEE REVERSE FOR
CERTAIN DEFINITIONS
CUSIP 336901 103
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THIS CERTIFIES that
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is the owner of
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TEN COM
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as tenants in common
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UNIF GIFT MIN ACT -
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Custodian
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(Cust)
(Minor)
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TEN ENT
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as tenants by the entireties
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under Uniform Gifts to Minors
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JT TEN
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as joint tenants with right of survivorship and not as tenants in common
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Act
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(State)
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For value received, _________________________________________________________hereby sell, assign and transfer unto
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PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE
__________________________________________ |
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Please print or typewrite name and address including postal zip code of assignee.
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Shares of the capital stock represented by the within Certificate, and do hereby irrevocably constitute and appoint |
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Attorney to transfer the said stock on the books of the within-named Corporation with full power of substitution in the premises.
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Dated, _________________________
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| ___________________________________________ | |