EX-4.1
from S-1/A
1 page
<page> Number Shares Forsyth Bancshares, Inc. Authorized to Issue 10,000,000 Shares of Common Stock - No Par Value This Certifies That Specimen Is the Registered Holder of Shares of the Authorized Common Stock of Forsyth Bancshares, Inc. Which Are Fully Paid and Non-Assessable and Which Are Transferable Only on the Books of the Corporation by the Holder Hereof in Person or by Attorney Upon Surrender of This Certificate Properly Endorsed. in Witness Whereof, the Said Corporation Has Caused This Certificate to Be Signed by Its Duly Authorized Officers and Its Corporate Seal to Be Hereunto Affixed This Day of A.D., 19 --- - Secretary President <page> 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 Ten Ent -- As Tenants by the Entireties Jt Ten -- As Joint Tenants With Right of Survivorship and Not as Tenants in Common Unif Gift Min Act -- Custodian (Cust) (Minor) Under Uniform Gifts to Minors Act (State) Additional Abbreviations May Also Be Used Thought 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 of Assignee - - Shares - Represented by the Within Certificate, and Do Hereby Irrevocably Constitute and Appoint - Attorney to Transfer the Said Shares on the Books of the Within-Named Corporation With Full Power of Substitution in the Premises. Dated, in Presence of 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
12/34/56