WITNESS Sample Clauses

WITNESS. EXHIBIT A FORM OF SUBSCRIPTION (to be signed only on exercise of Warrant) TO: BRAVO! FOODS INTERNATIONAL CORP. The undersigned, pursuant to the provisions set forth in the attached Warrant (No.____), hereby irrevocably elects to purchase (check applicable box): ___ ________ shares of the Common Stock covered by such Warrant; or ___ the maximum number of shares of Common Stock covered by such Warrant pursuant to the cashless exercise procedure set forth in Section 2. The undersigned herewith makes payment of the full purchase price for such shares at the price per share provided for in such Warrant, which is $___________. Such payment takes the form of (check applicable box or boxes): ___ $__________ in lawful money of the United States; and/or ___ the cancellation of such portion of the attached Warrant as is exercisable for a total of _______ shares of Common Stock (using a Fair Market Value of $_______ per share for purposes of this calculation); and/or ___ the cancellation of such number of shares of Common Stock as is necessary, in accordance with the formula set forth in Section 2, to exercise this Warrant with respect to the maximum number of shares of Common Stock purchasable pursuant to the cashless exercise procedure set forth in Section 2. The undersigned requests that the certificates for such shares be issued in the name of, and delivered to _____________________________________________________ whose address is _________________________________________________ ______________________________________ . The undersigned represents and warrants that all offers and sales by the undersigned of the securities issuable upon exercise of the within Warrant shall be made pursuant to registration of the Common Stock under the Securities Act of 1933, as amended (the "Securities Act"), or pursuant to an exemption from registration under the Securities Act. Dated:___________________ ----------------------------------------- (Signature must conform to name of holder as specified on the face of the Warrant) ----------------------------------------- ----------------------------------------- (Address) EXHIBIT B FORM OF TRANSFEROR ENDORSEMENT (To be signed only on transfer of Warrant) For value received, the undersigned hereby sells, assigns, and transfers unto the person(s) named below under the heading "Transferees" the right represented by the within Warrant to purchase the percentage and number of shares of Common Stock of BRAVO! FOODS INTERNATIONAL CORP. to wh...
AutoNDA by SimpleDocs
WITNESS. By: Name: Title: NOTARY PUBLIC My Commission expires: (COMPANY SEAL) Address: (NOTARY SEAL) NOTICE: WHEN YOU EXECUTE AND SUBMIT THIS DOCUMENT, YOU SHALL BE CONCLUSIVELY DEEMED TO HAVE BEEN PAID IN FULL THE AMOUNT STATED ABOVE, EVEN IF YOU HAVE NOT ACTUALLY RECEIVED SUCH PAYMENT, 60 DAYS AFTER THE DATE STATED ABOVE UNLESS YOU FILE EITHER AN AFFIDAVIT OF NONPAYMENT OR A CLAIM OF LIEN PRIOR TO THE EXPIRATION OF SUCH 60 DAY PERIOD. THE FAILURE TO INCLUDE THIS NOTICE LANGUAGE ON THE FACE OF THE FORM SHALL RENDER THE FORM UNENFORCEABLE AND INVALID AS A WAIVER AND RELEASE UNDER O.C.G.A. SECTION 00-00-000. Schedule E-5 Form of Conditional & Unconditional Interim Lien Waivers INTERIM WAIVER AND RELEASE UPON FINAL PAYMENT STATE OF GEORGIA COUNTY OF THE UNDERSIGNED MECHANIC AND/OR MATERIALMAN HAS BEEN EMPLOYED BY (NAME OF CONTRACTOR) TO FURNISH (DESCRIBE MATERIALS AND/OR LABOR) FOR THE CONSTRUCTION OF IMPROVEMENTS KNOWN AS (TITLE OF THE PROJECT OR BUILDING) WHICH IS LOCATED IN THE CITY OF SAVANNAH, COUNTY OF CHATHAM, AND IS OWNED BY (NAME OF OWNER) AND MORE PARTICULARLY DESCRIBED AS FOLLOWS: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) UPON THE RECEIPT OF THE SUM OF $ THE MECHANIC AND/OR MATERIALMAN WAIVES AND RELEASES ANY AND ALL LIENS OR CLAIMS OF LIENS IT HAS UPON THE FOREGOING DESCRIBED PROPERTY OR ANY RIGHTS AGAINST ANY LABOR AND/OR MATERIAL BOND ON ACCOUNT OF LABOR AND/OR MATERIAL BOND THROUGH , 20 , AND EXCEPTING THOSE RIGHTS AND LIENS THAT THE MECHANIC AND/OR MATERIALMAN MIGHT HAVE IN ANY RETAINED AMOUNTS, ON ACCOUNT OF LABOR OR MATERIALS, OR BOTH, FURNISHED BY THE UNDERSIGNED TO OR ON ACCOUNT OF SAID CONTRACTOR FOR SAID BUILDING OR PREMISES. [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK] [SIGNATURE PAGE TO WAIVER AND RELEASE UPON FINAL PAYMENT] GIVEN UNDER HAND AND SEAL THIS DAY OF , 20 . [COMPANY NAME]
WITNESS. EXECUTIVE /s/ Xxxxxx Xxxxxx /s/ Xxxxxxx X. Xxxxxxxxxx Xxxxxxx X. Xxxxxxxxxx
WITNESS the facsimile signature of the proper officers of the Company and its corporate seal. Dated as of ____________, _____. [SEAL] ATTEST: DOLLAR THRIFTY AUTOMOTIVE GROUP, INC. By: -------------------------------- --------------------------- Countersigned: HARRXX XXXST AND SAVINGS BANK By: ------------------------------ Authorized Signature 49 Form of Reverse Side of Right Certificate FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate) FOR VALUE RECEIVED, _______________ hereby sells, assigns and transfers unto ________________________________________________________________________________ (Please print name and address of transferee) ________________________________________________________________________________ this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _______________ Attorney, to transfer the within Right Certificate on the books of the within-named Company, with full power of substitution. Dated: , ---------- ----- ------------------------------- Signature Signature Guaranteed: 50 CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
WITNESS the facsimile signature of the proper officers of the Corporation and its corporate seal. Dated as of _____________, ____.
WITNESS. LESSOR: MEDITRUST ACQUISITION CORPORATION I, a Massachusetts corporation /s/ Xxxxx X. Xxxxxxx By: /s/ Xxxxxxx X. Xxxxxxxx, ESQ ------------------------ ------------------------------------- Name: Xxxxx X. Xxxxxxx Name: Xxxxxxx X. Xxxxxxxx, ESQ Title: Senior Vice President WITNESS: LESSEE: EMERITUS PROPERTIES I, INC., a Washington corporation /s/ Xxxx X. Xxxxxx By: /s/ Xxxxxxx X. Xxxxxxxxxx ---------------------------- ---------------------------------------- Name: Xxxx X. Xxxxxx Name: Xxxxxxx X. Xxxxxxxxxx Title: President COMMONWEALTH OF MASSACHUSETTS Norfolk, ss. February 11, 1997 Then personally appeared the above named Xxxxxxx X. Xxxxxxxx, Senior Vice President as aforesaid, and acknowledged the foregoing instrument to be his free act and deed and the free act and deed of Meditrust Acquisition Corporation I, before me, /s/ Xxx X. Xxxxxxxx --------------------------- Notary Public My commission expires: 8-2-2002 STATE OF WASHINGTON ) ) ss. COUNTY OF KING ) On this 6th day of February, 1997, before me, a Notary Public in and for the State of Washington, personally appeared Xxxxxxx X. Xxxxxxxxxx personally known to me (or proved to me on the basis of satisfactory evidence) to be the person who executed this instrument, and on oath stated that he was authorized to execute the instrument as the President of Emeritus Properties I, Inc., a Washington corporation, and acknowledged it to be the free and voluntary act and deed of corporation for the uses and purposes mentioned in the instrument.
WITNESS s/ Xxxxx X. Xxxxxxxxxxxx /s/ Xxxxxx X. Xxxxx Xxxxxx X. Xxxxx
WITNESS. ENGINEER: BY: Printed or Typed Name Printed or Typed Title Tax Identification No. ATTEST: CITY OF ARLINGTON, TEXAS: Xxxx Xxxxxx, City Secretary BY: Xxxxx X. Xxxxxxxx Printed or Typed Name Director of Water Utilities Printed or Typed Title APPROVED AS TO FORM: XXXXX XXXXX, City Attorney BY: THE STATE OF TEXAS § COUNTY OF TARRANT § Engineer Acknowledgment BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas, on this day personally appeared , known to me to be the person and officer whose name is subscribed to the foregoing instrument, and acknowledged to me that he executed same for and as the act of , a corporation of County, Texas, and as thereof, and for the purposes and consideration therein expressed and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE on this the , 20 . day of (SEAL) Notary Public in and for the State of Texas Notary's Printed Name My Commission Expires: THE STATE OF TEXAS § COUNTY OF TARRANT § Municipal Acknowledgment BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas, on this day personally appeared Xxxxx X. Xxxxxxxx, known to me to be the person and officer whose name is subscribed to the foregoing instrument, and acknowledged to me that he executed same for and as the act of the City of Arlington, Texas, a Texas municipal corporation, and as the Director of Water Utilities thereof, and for the purposes and consideration therein expressed and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE on this the , 20 . ___ day of (SEAL) Notary Public in and for the State of Texas Notary's Printed Name My Commission Expires: PRIME AND SUBS & MINORITY/WOMEN BUSINESS ENTERPRISE (MWBE) REPORT Please complete this form, include copy of certification(s) and return with executed contracts Project Name: Project No: Date: LEGEND
WITNESS. NOTICE: The signature on this assignment must correspond with the name as written upon the face of the within Warrant in every particular, without alteration or enlargement or any change whatsoever.