Common use of FORM OF ELECTION TO PURCHASE Clause in Contracts

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. The undersigned hereby irrevocably elects to exercise Rights -- evidenced by this Right Certificate to purchase the Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name of: Please insert social security or other identifying number: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: (Please print name and address) Date: , Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Omega Healthcare Investors Inc), Rights Agreement (Omega Healthcare Investors Inc)

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FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSO'REILLY AUTOMOTIVE, INC. .: The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , _______________,__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (O Reilly Automotive Inc), Rights Agreement (O Reilly Automotive Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) ToTo American Medical Security Group, Inc.: OMEGA HEALTHCARE INVESTORS, INC. The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the Preferred Stock Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: :______________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: :______________________ (Please print name and address) DateDated: , _______________,_____ ________________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (American Medical Security Group Inc), Rights Agreement (American Medical Security Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSENZON PHARMACEUTICALS, INC. .: The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________ (Please print name and address) ): If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date): Dated: , Signature Signature: Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Section 382 Rights Agreement (Enzon Pharmaceuticals, Inc.), Section 382 Rights Agreement (Enzon Pharmaceuticals, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. ACACIA RESEARCH CORPORATION: The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date: Dated _______________ ____, 20___ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Tax Benefits Preservation Plan (Acacia Research Corp), Tax Benefits Preservation Plan (Acacia Research Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSSWANK, INC. The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Series E Junior Participating Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ____________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number ____________________ (Please print name and address) DateDated: _____________________, _____ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Swank, Inc.), Rights Agreement (Swank, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, CXXXX & COMPANY INC. .: The undersigned hereby irrevocably elects to exercise ____________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ________________________ (Please print name and address) ): If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date): Dated: , Signature Signature: Signature Guaranteed*: * Signatures must be guaranteed by a participant in a Medallion Signature Guarantee Program at a guarantee level satisfactory to the Rights Agent. A notary public is not sufficient. Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Section 382 Rights Agreement (Cohen & Co Inc.), Section 382 Rights Agreement (Cohen & Co Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSSORRENTO THERAPEUTICS, INC. .: The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , Signature Signature Guaranteed: Certificate The undersigned hereby certifies Signatures must be guaranteed by checking a participant in the appropriate boxes that:Medallion Signature Guarantee Program at a guarantee level acceptable to the Company’s Rights Agent.

Appears in 2 contracts

Samples: Rights Agreement (Sorrento Therapeutics, Inc.), Rights Agreement (Sorrento Therapeutics, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSBEAZER HOMES USA, INC. .: The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) ): If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date): Dated: , Signature Signature: Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Section 382 Rights Agreement (Beazer Homes Usa Inc), Section 382 Rights Agreement (Beazer Homes Usa Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. FIRST AMERICAN CORPORATION The undersigned hereby irrevocably elects to exercise ___________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: _______________ , Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (First American Corp /Tn/)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORSFLORIDA EAST COAST INDUSTRIES, INC. The undersigned hereby irrevocably elects to exercise ____________ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: __________, ____ _____________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Florida East Coast Industries Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSEMBREX, INC. The undersigned hereby irrevocably elects to exercise ____________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) DateDated: __________________, 20__ Signature Signature Guaranteed: _____________________________ Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Embrex Inc /Nc/)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, EAGLE MATERIALS INC. The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Series A Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company Corporation or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and addressPLEASE PRINT NAME AND ADDRESS) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying numbernumber (PLEASE PRINT NAME AND ADDRESS) Dated: (Please print name and address) Date: , Signature Signature Guaranteed: Certificate 5 CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Eagle Materials Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. Triad Guaranty Inc. The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , ,20__ Signature Medallion Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Tax Benefits Preservation Plan (Triad Guaranty Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORSInterline Brands, INC. Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which that may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: ________________, ____ ______________________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Interline Brands, Inc./De)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. TASTY BAKING COMPANY The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Certificate to purchase the Preferred Stock Common Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name of: Please insert social security or other identifying number: number ___________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ___________________ (Please print name and address) DateDated: _________________, 200__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies Signatures must be guaranteed by checking an eligible financial institution or broker who is a member participant in a Medallion Program approved by the appropriate boxes that:Securities Transfer Association, Inc.

Appears in 1 contract

Samples: Rights Agreement (Tasty Baking Co)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, LONE STAR ENERGY PLANT OPERATIONS INC. : The undersigned hereby irrevocably elects to exercise _____________________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: ______________________, 19___ Signature Signature Guaranteed: 50 Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Lone Star Energy Plant Operations Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. THE STRIDE RITE CORPORATION: The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ------------------------------- (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number -------------------------------- (Please print name and address) DateDated: _______________ , 19 Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Stride Rite Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. ___________________ The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) _____________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) Date_____________________ _______________________________________ Dated: , Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Answerthink Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. ChinaCache International Holdings Ltd. The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the Preferred Stock Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: ________________________________________________ Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ________________________________________________ Please insert social security or other identifying number: number (Please print name and address) DateDated: , __________________,__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (ChinaCache International Holdings Ltd.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. PRIMESOURCE CORPORATION The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Certificate to purchase the Preferred Stock Common Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name of: Please insert social security or other identifying number: number ___________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number ---------------------------------------------------------- (Please print name and address) DateDated: _________________, 200__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies Signatures must be guaranteed by checking an eligible financial institution or broker who is a member participant in a Medallion Program approved by the appropriate boxes that:Securities Transfer Association, Inc.

Appears in 1 contract

Samples: Rights Agreement (Primesource Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. ROSEVILLE COMMUNICATIONS COMPANY The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Certificate to purchase the Preferred Stock Common Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which that may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock (or other securities) be issued in the name ofof and delivered to: (Please print name and address) (Please insert social security or other identifying number: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) (Please insert social security or other identifying number: (Please print name and address) DateDated: , Signature Signature: Signature Guaranteed: Certificate CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Roseville Communications Co)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. XXXXXX DRILLING COMPANY The undersigned hereby irrevocably elects to exercise _________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which that may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock (or other securities) be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: ____________, 20___ Signature Signature Guaranteed: Certificate The undersigned hereby certifies Signatures must be guaranteed by checking an “eligible guarantor institution” (as defined pursuant to Rule 17Ad-15 under the appropriate boxes that:Securities Exchange Act of 1934, as amended).

Appears in 1 contract

Samples: Rights Agreement (Parker Drilling Co /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. BALL CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) address If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Dateaddress Dated: __________________, ____ ___________________________ Signature Signature Medallion Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Ball Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. FURMANITE CORPORATION The undersigned hereby irrevocably elects to exercise ____________Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please please print name and address) DateDated: ___________________, _________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Furmanite Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSX. X. XXXXXX COMPANY, INC. .: The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date: Dated _______________ ____, 20___ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (J C Penney Co Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSHEALTH NET, INC. The undersigned hereby irrevocably elects to exercise __________________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: (Please print name and address) number If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying numbernumber ------------------------------------------------------------------------------ Dated: (Please print name and address) Date: ________________, 20___ ------------------------------ Signature Signature Medallion Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Health Net Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSCPEX PHARMACEUTICALS, INC. .: The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , ___ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (CPEX Pharmaceuticals, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORSTo CAPITAL TRUST, INC. .: The undersigned hereby irrevocably elects to exercise _____ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name of: Please insert social security or other identifying taxpayer number: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right CertificateCertificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying taxpayer number: (Please print name and address) DateDated: , _____ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Tax Benefits Preservation Rights Agreement (Capital Trust Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, EAGLE BULK SHIPPING INC. .: The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , __________________,__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Eagle Bulk Shipping Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. X. X. XXXXXXXXX & SONS COMPANY.: The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , __________________,__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (RR Donnelley & Sons Co)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. INSTINET GROUP INCORPORATED The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: __________________, _____ ______________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Instinet Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSINTERDIGITAL, INC. The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the Units of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock Units be issued in the name ofof and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) Date: , Signature Signature Guaranteed: Certificate CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (InterDigital, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. SUREWEST COMMUNICATIONS The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Certificate to purchase the Preferred Stock Common Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which that may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock (or other securities) be issued in the name ofof and delivered to: (Please print name and address) (Please insert social security or other identifying number: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) (Please insert social security or other identifying number) Dated: (Please print name and address) Date____________________, _____ Signature: , Signature ____________________ Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Surewest Communications)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, EAGLE BULK SHIPPING INC. .: The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , _______________,__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Eagle Bulk Shipping Inc.)

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FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSICONIX BRAND GROUP, INC. .: The undersigned hereby irrevocably elects to exercise [ ] Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , [ ],[ ] Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Iconix Brand Group, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. Houston Wire & Cable Company The undersigned hereby irrevocably elects to exercise ____________ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which that may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: ________________, ____ ______________________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Houston Wire & Cable CO)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSBEAZER HOMES USA, INC. .: The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) ): If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date): Dated: , Signature _________________________________ Signature: _________________________________ Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Section 382 Rights Agreement (Beazer Homes Usa Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORSPiccadilly Cafeterias, INC. Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: ________________, 19__ Signature Signature Guaranteed: Certificate PAGE CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Piccadilly Cafeterias Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. WYNDHAM WORLDWIDE CORPORATION The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Wyndham Worldwide Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. XXX.Xxxxxxxx Corporation The undersigned hereby irrevocably elects to exercise ____________ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date: Dated:__________________, 20__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (MSC Software Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. INTERDIGITAL COMMUNICATIONS CORPORATION The undersigned hereby irrevocably elects to exercise _________ Rights -- evidenced represented by this Right Rights Certificate to purchase the Units of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock Units be issued in the name ofof and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) --------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) Date: , -------------------------------- Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Interdigital Communications Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. CORECOMM LIMITED: The undersigned hereby irrevocably elects to exercise ___________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Series C Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which that may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , ______________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Corecomm LTD /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. ___________________ The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) DateDated: _____________, ____. Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Canwest Petroleum Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. Callidus Software Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: __________________, 20__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Callidus Software Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. ___________________ The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the Preferred shares of Common Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) DateDated: _____________, ____. Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Metalline Mining Co)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSTOLL BROTHERS, INC. .: The undersigned hereby irrevocably elects to exercise ___Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) ): If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date): Dated: , Signature Signature: Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Toll Brothers Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSX. X. XXXXXX COMPANY, INC. .: The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date: Dated _______________ ____, 20___ ___________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (J C Penney Co Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, DRIVE SHACK INC. The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which that may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , _____________,_____ Signature Signature Guaranteed: Certificate The undersigned hereby certifies Signature must be guaranteed by checking the appropriate boxes that:a bank, trust company, broker, dealer or other eligible institution participating in a recognized signature guarantee medallion program.

Appears in 1 contract

Samples: Tax Benefits Preservation Plan (Drive Shack Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSINSTITUTIONAL FINANCIAL MARKETS, INC. .: The undersigned hereby irrevocably elects to exercise Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) ): If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date): Dated: , Signature Signature: Signature Guaranteed*: * Signatures must be guaranteed by a participant in a Medallion Signature Guarantee Program at a guarantee level satisfactory to the Rights Agent. A notary public is not sufficient. Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Section 382 Rights Agreement (Institutional Financial Markets, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSThe Williams Companies, INC. Inc.: The undersigned hereby irrevocably elects xxxxxx to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: ___________, ____ ___________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Williams Companies Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Certificate.) ToTo FLUSHING FINANCIAL CORPORATION: OMEGA HEALTHCARE INVESTORS, INC. The undersigned hereby irrevocably elects to exercise _________ Rights -- evidenced represented by this Right Certificate to purchase the Preferred Stock Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name of: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) Date: Dated as of _______________, ____ Signature Signature Guaranteed: BACK Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Flushing Financial Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) ToTO: OMEGA HEALTHCARE INVESTORSSOLITRON DEVICES, INC. .: The undersigned hereby irrevocably elects to exercise _______ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: (Please print name and address of transferee) Please insert social security or other identifying number: (Please print name and address) _____________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address of transferee) Please insert social security or other identifying number:______________________ Dated: (Please print name and address) Date: , __________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Solitron Devices Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. Steel Excel Inc. The undersigned hereby irrevocably elects to exercise _______________ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and addressaddress of transferee) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and addressaddress of transferee) DateDated: __________, 20__ Signature Medallion Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Tax Benefits Preservation Plan (Steel Excel Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORSTo FRANKLIN ELECTRIC CO., INC. The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the Preferred shares of Preference Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person Person which may be issuable or such other assets which may be deliverable upon the exercise of the Rights) and requests that certificates for any such shares of stock or securities be issued in the name ofof and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) Please insert social security or other identifying number: (Please print name and address) DateDated: , Signature Signature Medallion Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Franklin Electric Co Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced represented by the Right Certificate.) To: OMEGA HEALTHCARE INVESTORS, INC. Wits Basin Precious Minerals Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights -- evidenced represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which that may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: ________________, _____ Signature Signature Guaranteed: Certificate CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Wits Basin Precious Minerals Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights evidenced represented by the Right Rights Certificate.) To: OMEGA HEALTHCARE INVESTORS, SOLUTIA INC. The undersigned hereby irrevocably elects to exercise __________ Rights -- evidenced represented by this Right Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares of stock be issued in the name ofof and delivered to: Please insert social security or other identifying number: number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number (Please print name and address) DateDated: , Signature _______________,__ _______________________________ Signature: Signature Guaranteed: K&E 15230038.6 Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: 382 Rights Agreement (Solutia Inc)

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