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EXHIBIT 4.1
INSURANCE
MANAGEMENT
SOLUTIONS
GROUP
NUMBER INCORPORATED UNDER THE LAWS OF THE STATE OF FLORIDA [SHARES]
[INMG 0001]
SEE REVERSE SIDE FOR CUSIP 458045 10 1
CERTAIN DEFINITIONS
INSURANCE MANAGEMENT SOLUTIONS GROUP, INC.
AUTHORIZED COMMON SHARES OF 100,000,000 PAR VALUE $0.01 EACH
This is to Certify that
ROBERT M. MENKE
is the owner of
FULLY PAID AND NON-ASSESSABLE COMMON SHARES OF INSURANCE MANAGEMENT SOLUTIONS GROUP, INC.
transferable on the books of the Corporation in person or by duly authorized Attorney whose surrender of this Certificate properly
endorsed. This certificate is not valid until countersigned by the Transfer Agent and registered by the
Registrar.
IN WITNESS WHEREOF, the Corporation has caused the facsimile signatures of its duly authorized officers and the facsimile
of its seal to be printed hereon.
Dated:
Countersigned and Registered:
Firstar Bank Milwaukee, N.A.
(Milwaukee, WI) Transfer Agent and Registrar
By
Authorized Signature
Kelly K. King [SEAL] David K. Meehan
SECRETARY CHAIRMAN OF THE BOARD
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THE RECORD HOLDER OF THIS CERTIFICATE MAY OBTAIN FROM THE SECRETARY OF THE
CORPORATION, UPON REQUEST AND WITHOUT CHARGE, A FULL STATEMENT OF THE
DESIGNATION, RELATIVE RIGHTS, PREFERENCES AND LIMITATIONS OF THE SHARES OF EACH
CLASS AUTHORIZED TO BE ISSUED AND THE DESIGNATION, RELATIVE RIGHTS, PREFERENCES
AND LIMITATIONS OF EACH SERIES OF PREFERRED SHARES AUTHORIZED TO BE ISSUED SO
FAR AS THE SAME HAVE BEEN FIXED AND THE AUTHORITY OF THE BOARD OF DIRECTORS TO
DESIGNATE AND FIX THE RELATIVE RIGHTS, PREFERENCES AND LIMITATIONS OF OTHER
SERIES.
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
TEN ENT- as tenants by the entireties ----- ------
JT TEN- as joint tenants with right of (Cust) (Minor)
survivorship and not as Under Uniform Gift to Minors
tenants in common
Act-
------------
(State)
UNIF TRANS MIN ACT Custodian
----- -------
(Cust) (Minor)
Under Uniform Transfer 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 OR ASSIGNEE
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(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, OF ASSIGNEE)
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Shares
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of the common stock represented by the million Certificate, and do hereby
irrevocable 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.
Date X
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X
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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,
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SIGNATURE GUARANTEED
THE SIGNATURES SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR
INSTITUTION (BANKS, STOCKHOLDERS, 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.