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If delivering by mail:
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If delivering by hand or courier:
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American Stock Transfer & Trust Company, LLC
Operations Center Attn: Reorganization Department P.O. Box 2042 New York, New York 10272-2042 |
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American Stock Transfer & Trust Company, LLC
Operations Center Attn: Reorganization Department 6201 15th Avenue Brooklyn, New York 11219 |
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DESCRIPTION OF SHARES SURRENDERED
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Name(s) and Address(es) of Registered Owner(s)
(If blank, please fill in exactly as name(s) appear(s) on share certificate(s)) |
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Shares Surrendered (attached additional list if necessary)
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Certificated Shares**
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Certificate
Number(s)* |
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Total Number of
Shares Represented by Certificate(s)* |
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Number of Shares
Surrendered** |
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Book Entry
Shares Surrendered |
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Total Shares
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| | | | | | | * Need not be completed by book-entry stockholders. ** Unless otherwise indicated, it will be assumed that all shares of common stock represented by certificates described above are being surrendered hereby. |
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Signature
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Date
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If delivering by mail:
American Stock Transfer & Trust Company, LLC Operations Center Attn: Reorganization Department P.O. Box 2042 New York, New York 10272-2042 |
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If delivering by hand or courier:
American Stock Transfer & Trust Company, LLC Operations Center Attn: Reorganization Department 6201 15th Avenue Brooklyn, New York 11219 |
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