EXHIBIT 4.1
COMMON STOCK COMMON STOCK
NNB
INCORPORATED UNDER THE LAWS THIS CERTIFICATE IS TRANSFERABLE IN
OF THE STATE OF WISCONSIN CINCINNATI, OHIO OR NEW YORK, NEW YORK
NICOLET BANKSHARES, INC
CUSIP 65406E 10 2
SEE REVERSE FOR
CERTAIN DEFINITIONS
This certifies that
is the registered holder of
FULLY PAID AND NON-ASSESSABLE SHARES OF COMMON STOCK, PAR VALUE OF $0.01 PER
SHARE, OF
NICOLET BANKSHARES, INC.
transferable on the books of the Corporation by the holder hereof, in person or
by duly authorized attorney, upon the surrender of this certificate properly
endorsed. This certificate is not valid until countersigned by the Transfer
Agent and registered by the Registrar.
Witness the facsimile signatures of its duly authorized officers.
Dated:
/s/ Robert B. Atwell /s/ Michael E. Daniels
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PRESIDENT AND CHIEF EXECUTIVE OFFICER SECRETARY
NICOLET BANKSHARES, INC.
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 (Cust) (Minor)
Of Survivorship and not as tenants in under Uniform Gifts to Minors Act
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(State)
UNIF TRF MIN ACT -. Custodian (until age)
---- -----
(Cust) (Minor)
under Uniform Gifts to Transfers
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(Minor)
to Minors Act
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(State)
For value received, hereby sells, assigns and
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transfers unto
PLEASE INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING NUMBER OF 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 stock represented by the within Certificate, and do hereby
irrevocably constitute and appoint
Attorney
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to transfer the said stock on the books of the within-named Bank with full
power of substitution in the premises.
Dated
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X
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X
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NOTICE:
THE SIGNATURE(S) 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.)
Signature(s) Guaranteed
By
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THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR
INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS
AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE
GUARANTEE MEDALLION PROGRAM) PURSUANT TO S.E.C. RULE 17 A-d 15.