Common use of FORM OF ELECTION TO PURCHASE Clause in Contracts

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:--------------------- The undersigned hereby irrevocably elects to exercise --------- -----------Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the following name: 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 Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- Dated: -------------------, ---------- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 2 contracts

Samples: Rights Agreement (Minerals Technologies Inc), Rights Agreement (Minerals Technologies Inc)

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FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:--------------------- TO:_________________ The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the following name: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _______________________ ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If _______________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________ Dated: -------------------________________, ---------- -------------------------------------- ____ _______________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C TO RIGHTS AGREEMENT FORM OF SECOND AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF MINERALS TECHNOLOGIES X. X. XXXXXX COMPANY, INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.X. X. Penney Company, Inc., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 2 contracts

Samples: Rights Agreement (Penney J C Co Inc), Rights Agreement (Penney J C Co Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: XXXX, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights ______________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Corporation or of any other Person which may be issuable upon the exercise of the Rights) and requests that certificates for such share(s) shares be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- ______________________________ ______________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ______________________________________________________________________________ Dated: -------------------___________________, ---------- -------------------------------------- ______ __________________________________________ Signature Signature Guaranteed: Signatures must be guaranteed by an eligible guarantor institution (Signature must conform including banks, stockbrokers, savings and loan associations, clearing agencies and credit unions with membership in all respects an approved signature guarantee medallion program) pursuant to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 Rule 17Ad-15 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized Securities and existing Exchange Commission under the laws Securities Exchange Act of the State of Delaware (the "Company")1934, DOES HEREBY CERTIFY:as amended.

Appears in 2 contracts

Samples: Rights Agreement (Culp Inc), Rights Agreement (Culp Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To: ORAPHARMA, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________ Rights represented by this Rights Right Certificate to purchase the shares of Series E Preferred Stock issuable upon the exercise of such 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 share(s) shares be issued in the following namename of and delivered to: ____________________________________________ (Please print name and address) _____________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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:_______________, _____ _______________________ Signature Signature Guaranteed: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------- Dated: -------------------________________________ Signatures must be guaranteed by a member firm of a registered United States national securities exchange, ---------- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCNational Association of Securities Dealers, Inc., or a commercial bank or trust company having an office or correspondent in the United States., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 2 contracts

Samples: Rights Agreement (Orapharma Inc), Rights Agreement (Orapharma Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:--------------------- TO:_________________ The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the following name: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (:_________________ Please print insert name and address) --------------------------------------------------------------If :____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (:_________________ ________________________________________________________________________________ ________________________________________________________________________________ Please print insert name and address) -------------------------------------------------------------------- :_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: -------------------______________, ---------- -------------------------------------- ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 2 contracts

Samples: Rights Agreement (Geoworks /Ca/), Rights Agreement (Geoworks /Ca/)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To TWEETER HOME ENTERTAINMENT GROUP, INC.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights _____________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights 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 share(s) shares be issued in the following namename of _________________________: Please insert social security or other identifying taxpayer number: ---------------------------------- -------------------------------------------------------------------- ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Right Certificate or if the Rights Certificateare being exercised pursuant to Section 11.1.2 of the Rights Agreement, a new Rights Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered toto ____________________: Please insert social security or other identifying taxpayer number: ---------------------------------- -------------------------------------------------------------------- Please insert social security or other identifying taxpayer number: ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ (Please print name and address) -------------------------------------------------------------------- DatedSignature:______________________ Signature Guaranteed: -------------------, ---------- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on CERTIFICATE The undersigned hereby certifies by checking the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 2 contracts

Samples: Shareholder Rights Agreement (Tweeter Home Entertainment Group Inc), Shareholder Rights Agreement (Tweeter Home Entertainment Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To: SELECT MEDICAL CORPORATION The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such 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 share(s) shares be issued in the following namename of and delivered to: ____________________________________________ (Please print name and address) _____________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- Dated: -------------------:_______________, ---------- -------------------------------------- _____ _______________________ Signature (Signature Guaranteed:__________________________ Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a registered United States national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., or a commercial bank or trust company organized and existing under having an office or correspondent in the laws of United States. CERTIFICATE The undersigned hereby certifies by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Select Medical Corp), Rights Agreement (Select Medical Corp)

FORM OF ELECTION TO PURCHASE. (a) (To be executed if registered holder desires desire to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: SEQUUS PHARMACEUTICALS, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights 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 share(s) shares be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- :______________________ ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________ ________________________________________________________________________________ Dated: -------------------___________________, ---------- -------------------------------------- 19___. _______________________ Signature (Signature Guaranteed: Signatures must conform be guaranteed by a bank, broker, dealer, credit union or savings association or other entity that is a member in all respects to name good standing of holder as specified on a signature guarantee medallion program approved by the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of Securities Transfer Association, Inc. Certificate ----------- The undersigned hereby certifies by checking the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Sequus Pharmaceuticals Inc), Rights Agreement (Sequus Pharmaceuticals Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights represented by this Right Certificate.) TO:--------------------- To Consolidated Graphics, Inc.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights ___________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) be of Preferred Stock (or such other securities)be issued in the following name: ________________________________________________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- ) ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________ Dated: -------------------__________________, ---------- -------------------------------------- ______. ____________________________________ Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a registered national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCNational Association of Securities Dealers, Inc., or a commercial bank or trust company having an office or correspondent in the United States., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 2 contracts

Samples: Rights Agreement (Consolidated Graphics Inc /Tx/), Rights Agreement (Consolidated Graphics Inc /Tx/)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Right Certificate.) TO:--------------------- To CRITICARE SYSTEMS, INC.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights Rights represented by this Rights Right Certificate to purchase the shares of one one-hundredth Preferred Stock Shares issuable upon the exercise of such Rights and requests that certificates for such share(s) Preferred Shares be issued in the following namename of: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number ________________________________________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ________________________________________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________________________________________ Dated:________________, 20__ ________________________________ Signature Signature Guaranteed: -------------------Signatures must be guaranteed by a member firm of a registered national securities exchange, ---------- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Form of Reverse Side of Right Certificate -- continued Dealers, Inc., or a commercial bank or trust company organized and existing under having an office or correspondent in the laws of United States. ------------------------------------------------------------------------------------------------------------------------------------- The undersigned hereby certifies that the State of Delaware Rights evidenced by this Right Certificate are not beneficially owned by an Acquiring Person or an Affiliate or Associate thereof (as defined in the "Company"Rights Agreement), DOES HEREBY CERTIFY:. _______________________________

Appears in 1 contract

Samples: Rights Agreement (Criticare Systems Inc /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:--------------------- TO VITALWORKS INC.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights _____________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the following name: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- ______________________________________ _______________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If _______________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- _______________________________________________________________________________ Dated: -------------------________________, ---------- -------------------------------------- ____ ____________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS DESIGNATION OF SERIES A JUNIOR B PREFERRED STOCK OF MINERALS TECHNOLOGIES VITALWORKS INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.I, [name] , [office] of VitalWorks Inc., a company corporation organized and existing under the laws of the State of Delaware General Corporation Law (the "CompanyCorporation"), DOES in accordance with the provisions of Section 151 of such law, DO HEREBY CERTIFYCERTIFY that pursuant to the authority conferred upon the Board of Directors by the Certificate of Incorporation of the Corporation, the Board of Directors on December 5, 2002 adopted the following resolution which creates a series of 200,000 shares of Preferred Stock designated as Series B Preferred Stock, as follows: RESOLVED, that pursuant to Section 151(g) of the Delaware General Corporation Law and the authority vested in the Board of Directors of the Corporation in accordance with the provisions of ARTICLE Fourth of the Certificate of Incorporation of the Corporation, a series of Preferred Stock of the Corporation be, and hereby is, created, and the powers, designations, preferences and relative, participating, optional or other special rights of the shares of such series, and the qualifications, limitations or restrictions thereof, be, and hereby are, as follows:

Appears in 1 contract

Samples: Rights Agreement (Vitalworks Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To Kana Software, Inc.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights Rights represented by this Rights Right Certificate to purchase the shares one one-hundredths of a Preferred Stock Share or other securities issuable upon the exercise of such Rights and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- __________________________________________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If __________________________________________________________________________________________________________________ If such number of Rights shall is not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _____________________________________________________________ __________________________________________________________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- __________________________________________________________________________________________________________________ Dated: -------------------, ---------- -------------------------------------- Signature Signature(s) Guaranteed: SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.BANKS, a company organized and existing under the laws of the State of Delaware (the "Company"STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), DOES HEREBY CERTIFY:PURSUANT TO S.E.C. RULE 17Ad-15. The undersigned hereby certifies that the Rights evidenced by this Right Certificate are not beneficially owned by an Acquiring Person or an Affiliate or Associate thereof (as defined in the Rights Agreement). Signature

Appears in 1 contract

Samples: Rights Agreement (Kana Software Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: TOYS "R" US, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights ____________ Rights represented by this Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights consideration or 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 share(s) shares be issued in the following namename of and deliverable to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number _________________________________________________________ (Please print name and address) --------------------------------------------------------------If _________________________________________________________ _________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- _________________________________________________________ _________________________________________________________ Dated:________________, _____ _________________________________ Signature Signature Guaranteed: -------------------____________________ Signatures must be guaranteed by an eligible guarantor institution (a bank, ---------- -------------------------------------- Signature (Signature must conform stockbroker, savings and loan association or credit union with membership in all respects an approved signature guarantee medallion program) pursuant to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 Rule 17Ad-15 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCSecurities Exchange Act of 1934., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Toys R Us Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights CertificateCertificate other than pursuant to SECTION 11(a)(ii) of the Rights Agreement.) TO:--------------------- To: US Dataworks, Inc. The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________ Rights represented by this Rights Certificate to purchase the shares one one-thousandths of a share of Preferred Stock (or such other securities of the Company or any other Person) issuable upon the exercise of such the Rights and requests that certificates for such share(s) shares be issued in the following namename of: ________________________________________________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- ) ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If such number of Rights shall not be all ________________________________________________________________________________ If applicable, the Rights evidenced by this Rights CertificateCertificate indicating the balance, a new Rights Certificate for the balance remaining if any, of such Rights which may still be exercised pursuant to SECTION 11(a)(ii) of the Rights Agreement shall be returned to the undersigned unless such Person requests that the Rights Certificate be registered in the name of and delivered to: ________________________________________________________________________________ Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number (complete only if Rights Certificate is to be registered in a name other than the undersigned) ________________________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- ________________________________________________________________________________ Dated: -------------------____________, ---------- -------------------------------------- 20__. __________________________________ Signature (Signature Guaranteed: Signatures must conform be guaranteed by an Eligible Guarantor Institution, as defined in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing Rule 17Ad-15 under the laws Securities Exchange Act of 1934. CERTIFICATE ----------- The undersigned hereby certifies by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Us Dataworks Inc)

FORM OF ELECTION TO PURCHASE. (a) (To be executed signed if registered holder desires holders desire to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: PENEDERM INCORPORATED The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights 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 share(s) shares be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- :___________________ _____________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If _____________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- _____________________________________________________________________________ _____________________________________________________________________________ Dated: -------------------_______________________. _______________________ Signature Signature Guaranteed: Signatures must be guaranteed by a bank, ---------- -------------------------------------- Signature (Signature must conform broker, dealer, credit union or savings association or other entity that is a member in all respects to name good standing of holder as specified on a signature guarantee medallion program approved by the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of Securities Transfer Association, Inc. Certificate ----------- The undersigned hereby certifies by checking the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Penederm Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights CertificateCertificate other than pursuant to Section 11(a)(ii) of the Rights Agreement.) TO:--------------------- To ALLIED WASTE INDUSTRIES, INC.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights ___________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock (or such other securities of the Company or any other Person) issuable upon the exercise of such the Rights and requests that certificates for such share(s) shares be issued in the following namename 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 Rights Certificate, a new -------------------------------------------------------------------------------- The Rights Certificate for indicating the balance remaining balances, if any, of such Rights which may still be exercised pursuant to each of Section 11(a)(ii) and Section 13 of the Rights Agreement shall be returned to the undersigned unless such person requests that the Rights Certificate be registered in the name of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number (complete only if Rights Certificate is to be registered in a name other than the undersigned) -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: -------------------__________________, ---------- -------------------------------------- 20__ ------------------------------------ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Allied Waste Industries Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: EGL, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If number -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: -------------------, ---------- -------------------------------------- 200 ------------ --- --------------------------------- Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of 1934, as amended). CERTIFICATE The undersigned hereby certifies by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Egl Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:--------------------- To Hovnanian Enterprises, Inc.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights ________________ Rights represented by this Rights Certificate to purchase the shares one ten-thousandths of a Preferred Stock Share or other securities issuable upon the exercise of such Rights and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _________________________ ______________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If If such number of Rights shall is not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _______________________________ ______________________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- Dated: -------------------___________, ---------- -------------------------------------- __________________ __________________________________________ Signature Signature(s) Guaranteed: SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Signature must conform in all respects to name of holder as specified on BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 17Ad-15. _________________ The undersigned hereby certifies that the fact of Rights evidenced by this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INCCertificate are not beneficially owned by an Acquiring Person or an Affiliate or Associate thereof (as defined in the Rights Agreement). Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:__________________________________________ Signature

Appears in 1 contract

Samples: Rights Agreement (Hovnanian Enterprises Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To: AmeriSource Health Corporation The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- Dated: -------------------_______________, ---------- -------------------------------------- _____ __________________________________ Signature (Signature Guaranteed:__________________________ Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a registered United States national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCNational Association of Securities Dealers, Inc., or a commercial bank or trust company having an office or correspondent in the United States., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Amerisource Health Corp/De)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:--------------------- TO:_________________ The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the following name: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If _______________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________ Dated: -------------------________________, ---------- -------------------------------------- ____ _____________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF MINERALS TECHNOLOGIES LODGIAN, INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.I, [name] , [office] of Lodgian, Inc., a company corporation organized and existing under the laws of the State of Delaware General Corporation Law (the "CompanyCorporation"), DOES in accordance with the provisions of Section 151 of such law, DO HEREBY CERTIFYCERTIFY that pursuant to the authority conferred upon the Board of Directors by the Restated Certificate of Incorporation of the Corporation, the Board of Directors on March 26, 1999 adopted the following resolution which creates a series of [________] shares of Preferred Stock designated as Participating Preferred Stock, as follows:

Appears in 1 contract

Samples: Rights Agreement (Lodgian Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: COMPANY ------------------------ The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number -------------------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: -------------------, ---------- -------------------------------------- 199 ------------ ---------------------------------------- Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of the State of Delaware (the "Company"1934, as amended), DOES HEREBY CERTIFY:.

Appears in 1 contract

Samples: Rights Agreement (Pennzoil Products Co)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: MMI COMPANIES, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights ________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights 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 share(s) shares be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________ ________________________________________________________________________________ Dated:______________ ________________________________________ Signature Medallion Signature Guaranteed: -------------------, ---------- -------------------------------------- Signature (Signature must conform be guaranteed by a commercial bank or trust company, broker, dealer, or other eligible institution which is a member in all respects to name good standing of holder as specified on a medallion guaranty program approved by the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of Securities Transfer Association, Inc. Certificate ----------- The undersigned hereby certifies by checking the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Mmi Companies Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To: GENZYME CORPORATION The undersigned hereby irrevocably elects to exercise --------- -----------Rights _______ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of such Rights and requests that certificates for such share(s) Preferred Shares be issued in the following namename of: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number _______________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Form of Reverse Side of Right Certificate -- continued _______________________________________________________________________________ Right Certificate for the balance remaining 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) -------------------------------------------------------------------- _______________________________________________________________________________ Dated: -------------------:________________________, ---------- -------------------------------------- ____ _____________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights CertificateRight Certificate in every particular, without alteration or enlargement or any change whatsoever) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 Guaranteed: Signatures must be guaranteed by a member firm of a registered national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., or a commercial bank or trust company organized and existing under having an office or correspondent in the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:United States. _______________________________________________________________________________

Appears in 1 contract

Samples: Renewed Rights Agreement (Genzyme Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: CLECO CORPORATION The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________ Rights represented by this Rights Certificate to purchase the shares of $25 Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________ Dated: -------------------____________, ---------- -------------------------------------- 20__ __________________________________ Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of the State of Delaware (the "Company"1934, as amended), DOES HEREBY CERTIFY:.

Appears in 1 contract

Samples: Rights Agreement (Cleco Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: PRIDE INTERNATIONAL, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights ________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number -------------------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: -------------------, ---------- -------------------------------------- 200 ----------------- -- ------------------------------ Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of the State of Delaware (the "Company"1934, as amended), DOES HEREBY CERTIFY:.

Appears in 1 contract

Samples: Rights Agreement (Pride International Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:--------------------- To Charter Communications, Inc.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights ________________ Rights represented by this Rights Certificate to purchase the shares one one-thousandths of a Preferred Stock Share or other securities issuable upon the exercise of such Rights and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _________________________ ______________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If If such number of Rights shall is not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _______________________________ ______________________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- Dated: -------------------___________, ---------- -------------------------------------- __________________ __________________________________________ Signature Signature(s) Guaranteed: SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Signature must conform in all respects to name of holder as specified on BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 17Ad-15. _________________ The undersigned hereby certifies that the fact of Rights evidenced by this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INCCertificate are not beneficially owned by an Acquiring Person or an Affiliate or Associate thereof (as defined in the Rights Agreement). Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:__________________________________________ Signature

Appears in 1 contract

Samples: Rights Agreement (Charter Communications Inc /Mo/)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: DYCOM INDUSTRIES, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights ______ Rights represented by this Rights Certificate to purchase the shares Units of Preferred Stock issuable upon the exercise of the Rights (or such Rights 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 share(s) Units be issued in the following namename of and delivered to: -------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------- Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If -------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- -------------------------- Dated: -------------------___________________ ________________________________ Signature Signature Guaranteed: Signatures must be guaranteed by a member firm of a registered national securities exchange, ---------- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., or a commercial bank or trust company organized and existing under having an office or correspondent in the laws of United States. CERTIFICATE ----------- The undersigned hereby certifies by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Shareholder Rights Agreement (Dycom Industries Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To TWEETER HOME ENTERTAINMENT GROUP, INC.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights _____________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights 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 share(s) shares be issued in the following namename of _________________________: Please insert social security or other identifying taxpayer number: ---------------------------------- -------------------------------------------------------------------- ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Right Certificate or if the Rights Certificateare being exercised pursuant to Section 11.1.2 of the Rights Agreement, a new Rights Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to____________________: Please insert social security or other identifying taxpayer number: ---------------------------------- -------------------------------------------------------------------- Please insert social security or other identifying taxpayer number: ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ (Please print name and address) -------------------------------------------------------------------- DatedSignature:_________________________ Signature Guaranteed: -------------------, ---------- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on CERTIFICATE The undersigned hereby certifies by checking the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Shareholder Rights Agreement (Tweeter Home Entertainment Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Right Certificate.) TO:--------------------- To: SOFTWARE PUBLISHING CORPORATION HOLDINGS, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights _____________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of such Rights and requests that certificates for such share(s) Preferred Shares be issued in the following namename of: -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Please print name and address) Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If _____________________ If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- _____________________ Dated: -------------------________________, ---------- -------------------------------------- ____ -------------------------------------------------------------------------------- Signature Signature Guaranteed: Signatures must be guaranteed by an eligible guarantor institution (Signature must conform a bank, stock broker, savings and loan association or credit union with membership in all respects an approved signature guarantee program) pursuant to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 Rule 17Ad-15 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCSecurities Exchange Act of 1934. -------------------------------------------------------------------------------- The undersigned hereby certifies that the Rights evidenced by this Right Certificate are not beneficially owned by an Acquiring Person or an Affiliate or Associate thereof (as defined in the Rights Agreement)., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Software Publishing Corp Holdings Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: COOPXX XXXUSTRIES, INC.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights 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 share(s) shares be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number -------------------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: -------------------, ---------- -------------------------------------- --------------- ---- ------------------------ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Cooper Industries Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: U.S. CONCRETE, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________ Dated: -------------------____________, ---------- -------------------------------------- 199__ ________________________________________ Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of the State of Delaware (the "Company"1934, as amended), DOES HEREBY CERTIFY:.

Appears in 1 contract

Samples: Rights Agreement (Us Concrete Inc)

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FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: OCEANEERING INTERNATIONAL, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights ___________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________ Dated: -------------------:_________________________, ---------- 200__ -------------------------------------- Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of 1934, as amended). Certificate The undersigned hereby certifies by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Oceaneering International Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: PRIDE INTERNATIONAL, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number ________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ________________________________________________________________________________ Dated: -------------------____________, ---------- -------------------------------------- 199__ __________________________________ Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of the State of Delaware (the "Company"1934, as amended), DOES HEREBY CERTIFY:.

Appears in 1 contract

Samples: Rights Agreement (Pride International Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To: INTERSIL CORPORATION The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such 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 share(s) shares be issued in the following namename of and delivered to: ____________________________________________ (Please print name and address) ____________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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:_______________, _____ _______________________ Signature Signature Guaranteed:__________________________ Signatures must be guaranteed by an eligible guarantor institution (Please print name a bank, stockbroker, savings and addressloan association or credit union with membership in an approved signature guarantee medallion program) -------------------------------------------------------------------- Dated: -------------------, ---------- -------------------------------------- Signature (Signature must conform in all respects pursuant to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 Rule 17Ad-15 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under Securities Exchange Act of 1934. CERTIFICATE The undersigned hereby certifies by checking the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Intersil Corp/De)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To: Crown Cork & Seal Company, Inc. The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- Dated: -------------------_______________, ---------- -------------------------------------- _____ ___________________________________ Signature (Signature Guaranteed: _____________________________ Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a registered United States national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCNational Association of Securities Dealers, Inc., or a commercial bank or trust company having an office or correspondent in the United States., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Crown Cork & Seal Co Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To: AmeriSource Health Corporation The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- Dated: -------------------_______________, ---------- -------------------------------------- _____ ____________________________ Signature (Signature Guaranteed:_______________________ Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a registered United States national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCNational Association of Securities Dealers, Inc., or a commercial bank or trust company having an office or correspondent in the United States., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Amerisource Health Corp/De)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- Olympic Steel, Inc. The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________ Rights represented by this Rights Right Certificate to purchase the shares one one-hundredths of a Preferred Stock Share or other securities issuable upon the exercise of such Rights and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- :________________ ----------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If ----------------------------------------------------------------------- If such number of Rights shall is not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- ______________________________ _______________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- _______________________________________________________________________ Dated: -------------------________________, ---------- -------------------------------------- 20____ ___________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that: (Signature must conform in all respects 1) the Rights evidenced by this Right Certificate [ ] are [ ] are not being exercised by or on behalf of a Person who is or was an Acquiring Person or an Affiliate or Associate of any such Person (as such terms are defined pursuant to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"Agreement), DOES HEREBY CERTIFY:;

Appears in 1 contract

Samples: Rights Agreement (Olympic Steel Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- TO: GIGA-TONICS INCORPORATED The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of such Rights and requests that certificates for such share(s) Preferred Shares be issued in the following namename of: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number ______________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- ______________________________________________________________________________ Dated: -------------------___________________, ---------- -------------------------------------- _____ Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights CertificateRight Certificate in every particular, without alteration or enlargement or any change whatsoever) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 Guaranteed: Signatures must be guaranteed by a member firm of a registered national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc. or a commercial bank or trust company organized and existing under having an office or correspondent in the laws of United States. The undersigned hereby certifies that the State of Delaware Rights evidenced by this Right Certificate are not Beneficially Owned by a 15% Shareholder or an Affiliate or Associate thereof (as defined in the "Company"Rights Agreement), DOES HEREBY CERTIFY:. Signature

Appears in 1 contract

Samples: Rights Agreement (Giga Tronics Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Right Certificate pursuant to Section 11(a)(ii) of the Rights CertificateAgreement.) TO:--------------------- To GENERAL EMPLOYMENT ENTERPRISES, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Common Stock or other securities or property issuable upon the exercise of such Rights and requests that certificates for such share(s) shares be issued in the following namename 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 Rights Certificate, a new ______________________________________________________________________ The Rights Certificate for indicating the balance remaining balance, if any, of such Rights that may still be exercised pursuant to Section 11(a)(ii) of the Rights Agreement shall be returned to the undersigned unless such person requests that the Rights Certificate be registered in the name of and delivered to: ______________________________________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- .) (Complete only if the Rights Certificate is to be registered in a name other than the undersigned's.) ______________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- ______________________________________________________________________ Dated: -------------------____________ __, ---------- -------------------------------------- ____ ______________________________ Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a registered national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCNational Association of Securities Dealers, Inc., or a commercial bank, savings association, credit union or trust company having an office or correspondent in the United States or other eligible guarantor institution which is a participant in a signature guarantee medallion program., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (General Employment Enterprises Inc)

FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if registered such holder desires to exercise the Rights evidenced by this Right Certificate.) TO:--------------------- To: Payment Data Systems, Inc. The undersigned hereby irrevocably elects to exercise --------- -----------Rights represented _______ Rights evidenced by this Rights Right Certificate to purchase the shares of Preferred Stock issuable securities or other property due upon the exercise of such Rights and requests that certificates for any such share(s) securities be issued in the following namename of: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- ______________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If ______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, Right Certificate a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ______________________________________________________________________________ Dated: -------------------__________________________ ____________________________________ Signature MEDALLION SIGNATURE GUARANTEE: Signatures must be guaranteed by a member firm of a registered national securities exchange, ---------- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., or a commercial bank or trust company organized having an office or correspondent in the United States. ______________________________________________________________________________ The undersigned hereby certifies that the Rights evidenced by this Right Certificate are not beneficially owned by, and existing under were not acquired by the laws of undersigned from, an Acquiring Person or an Affiliate or Associate thereof (as defined in the State of Delaware (the "Company"Rights Agreement), DOES HEREBY CERTIFY:. ____________________________________ Signature

Appears in 1 contract

Samples: Rights Agreement (Payment Data Systems Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To: SCPIE HOLDINGS INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of such Rights (or such other securities or property of the Company or of any other Person which may be issuable upon the exercise of the Rights) and requests that certificates for such share(s) shares be issued in the following namename of: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number ____________________________________________________________ (Please print name and address) --------------------------------------------------------------If ____________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- ____________________________________________________________ Dated: -------------------__________________ ______________________________________ Signature Signature Guaranteed: _____________________________ Signatures must be guaranteed by a member firm of a registered national securities exchange, ---------- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., or a commercial bank or trust company organized and existing under having an office or correspondent in the laws of United States. The undersigned hereby certifies by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Scpie Holdings Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:--------------------- To: American Water Works Company, Inc. The undersigned hereby irrevocably elects to exercise --------- -----------Rights Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: ___________________________________________________________________________ (Please print name and address) ___________________________________________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- Dated: -------------------:___________________, ---------- -------------------------------------- ____ _______________________________________ Signature (Signature Guaranteed:______________________________________ Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a registered national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCNational Association of Securities Dealers, Inc., or a commercial bank or trust company having an office or correspondent in the United States., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (American Water Works Co Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights CertificateCertificate pursuant to Section 11(a)(ii) of the Rights Agreement.) TO:--------------------- To: CLEARWATER PAPER CORPORATION The undersigned hereby irrevocably elects to exercise --------- -----------Rights Rights represented by this Rights Certificate to purchase the shares of Preferred Common Stock (or such other securities of the Company) issuable upon the exercise of such the Rights and requests that certificates for such share(s) shares be issued in the following namename 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 Rights Certificate, a new ____________________________________________________________________________ The Rights Certificate for indicating the balance remaining balance, if any, of such Rights which may still be exercised pursuant to Section 11(a)(ii) of the Rights Agreement shall be returned to the undersigned unless the undersigned requests that the Rights Certificate be registered in the name of and delivered to: ____________________________________________________________________________ Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number (complete only if Rights Certificate is to be registered in a name other than the undersigned) ____________________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- ____________________________________________________________________________ Dated: -------------------, ---------- -------------------------------------- 20 . Signature (Signature Medallion Guaranteed: Signatures must conform be guaranteed by a member or participant in all respects to name of holder as specified on the fact of this Rights Certificate) Securities Transfer Agent Medallion Program, the New York Stock Exchange Medallion Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of Program or the Delaware General Corporation Law MINERALS TECHNOLOGIES INCStock Exchange Medallion Program., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Clearwater Paper Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:--------------------- To: DRIL-QUIP, INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights _________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number ------------------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If ------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining 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) -------------------------------------------------------------------- ------------------------------------------------------------------------------- Dated: -------------------____________, ---------- -------------------------------------- 199__ ---------------------------------- Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of the State of Delaware (the "Company"1934, as amended), DOES HEREBY CERTIFY:.

Appears in 1 contract

Samples: Rights Agreement (Dril-Quip Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:--------------------- To Charter Communications, Inc.: The undersigned hereby irrevocably elects to exercise --------- -----------Rights ________________ Rights represented by this Rights Certificate to purchase the shares one one-thousandths of a Preferred Stock Share or other securities issuable upon the exercise of such Rights and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _________________________ (Please print name and address) --------------------------------------------------------------If If such number of Rights shall is not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _______________________________ ______________________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- Dated: -------------------___________, ---------- -------------------------------------- __________________ __________________________________________ Signature Signature(s) Guaranteed: SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Signature must conform in all respects to name of holder as specified on BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 17Ad-15. _________________ The undersigned hereby certifies that the fact of Rights evidenced by this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INCCertificate are not beneficially owned by an Acquiring Person or an Affiliate or Associate thereof (as defined in the Rights Agreement). Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:__________________________________________ Signature

Appears in 1 contract

Samples: Rights Agreement (Charter Communications Inc /Mo/)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights CertificateCertificate other than pursuant to Section 11(a)(ii) of the Rights Agreement.) TO:--------------------- To: CLEARWATER PAPER CORPORATION The undersigned hereby irrevocably elects to exercise --------- -----------Rights Rights represented by this Rights Certificate to purchase the shares one one-thousandths of a share of Preferred Stock (or such other securities of the Company or any other Person) issuable upon the exercise of such the Rights and requests that certificates for such share(s) shares be issued in the following namename of: ____________________________________________________________________________ (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- ) ____________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If such number of Rights shall not be all ____________________________________________________________________________ If applicable, the Rights evidenced by this Rights CertificateCertificate indicating the balance, a new Rights Certificate for the balance remaining if any, of such Rights which may still be exercised pursuant to Section 11(a)(ii) of the Rights Agreement shall be returned to the undersigned unless such Person requests that the Rights Certificate be registered in the name of and delivered to: ____________________________________________________________________________ Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number (complete only if Rights Certificate is to be registered in a name other than the undersigned) ____________________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- Dated: -------------------, ---------- -------------------------------------- 20__. ________________________ Signature (Signature Medallion Guaranteed: Signatures must conform be guaranteed by a member or participant in all respects to name of holder as specified on the fact of this Rights Certificate) Securities Transfer Agent Medallion Program, the New York Stock Exchange Medallion Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of Program or the Delaware General Corporation Law MINERALS TECHNOLOGIES INCStock Exchange Medallion Program., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Clearwater Paper Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Right Certificate.) TO:--------------------- To: SOTHEBY’S The undersigned hereby irrevocably elects to exercise --------- -----------Rights exercise______________________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of such Rights and requests that certificates for such share(s) Preferred Shares be issued in the following namename of: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- number _____________________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining 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) -------------------------------------------------------------------- ______________________________________________________________________________________ (Please print name and address) Dated: -------------------, ---------- -------------------------------------- _______________ Signature Signature Guaranteed: Signatures must be guaranteed by a member or participant in the Medallion Signature Guarantee Program at a guarantee level acceptable to the Company’s Transfer Agent. The undersigned hereby certifies that the Rights evidenced by this Right Certificate are not Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof (Signature must conform as defined in all respects the Agreement) and are not issued with respect to name of holder as specified on the fact of this Rights CertificateNotional Common Shares related to a Derivatives Contract described in clause (iv) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under definition of Beneficial Owner (as such terms are defined in the laws of the State of Delaware (the "Company"Agreement), DOES HEREBY CERTIFY:. Signature

Appears in 1 contract

Samples: Rights Agreement (Sothebys)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights represented by this Rights Certificate.) TO:--------------------- To: Commonwealth Energy Corporation The undersigned hereby irrevocably elects to exercise --------- -----------Rights __________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock ______________ or other securities, cash or other property issuable upon the exercise of such Rights and requests that certificates for such share(s) shares or other securities be issued in the following namename of, and such cash or other property be paid to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------- (Please print name and address) --------------------------------------------------------------If -------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the remaining balance remaining 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) -------------------------------------------------------------------- -------------------------------------------------------------------------- Dated: -------------------, ---------- -------------------------------------- 20 Signature ----------- --- -- ----------------------------------- (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 Guaranteed: Signatures must be guaranteed by a member firm of a registered national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INCNational Association of Securities Dealers, Inc., or a commercial bank or trust company having an office or correspondent in the United States., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Commonwealth Energy Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Right Certificate pursuant to Section 11(a)(ii) of the Rights CertificateAgreement.) TO:--------------------- To XXXXXX RUBBERMAID INC. The undersigned hereby irrevocably elects to exercise --------- -----------Rights _____________________________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Common Stock or other securities or property issuable upon the exercise of such Rights and requests that certificates for such share(s) shares be issued in the following namename 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 Rights Certificate, a new The Rights Certificate for indicating the balance remaining balance, if any, of such Rights that may still be exercised pursuant to Section 11(a)(ii) of the Rights Agreement shall be returned to the undersigned unless such person requests that the Rights Certificate be registered in the name of and delivered to: (Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- .) (Complete only if the Rights Certificate is to be registered in a name other than the undersigned's.) (Please print name and address) -------------------------------------------------------------------- Dated: -------------------__________ __, ---------- -------------------------------------- ____ Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 a registered national securities exchange, a member of the Delaware General Corporation Law MINERALS TECHNOLOGIES INC.National Association of Securities Dealers, Inc., or a commercial bank, savings association, credit union or trust company organized and existing under having an office or correspondent in the laws United States or other eligible guarantor institution which is a participant in a signature guarantee medallion program. [Form of Reverse Side of Rights Certificate -- continued] Certificate ----------- The undersigned hereby certifies that by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Newell Rubbermaid Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:--------------------- To Abraxas Petroleum Corporation: The undersigned hereby irrevocably elects to exercise --------- -----------Rights ________________ Rights represented by this Rights Certificate to purchase the shares one ten−thousandths of a Preferred Stock Share or other securities issuable upon the exercise of such Rights and requests that certificates for such share(s) securities be issued in the following namename of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _________________________ ______________________________________________________________________________ (Please print name and address) --------------------------------------------------------------If If such number of Rights shall is not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Please insert social security or other identifying number: ---------------------------------- -------------------------------------------------------------------- _______________________________ ______________________________________________________________________________ (Please print name and address) -------------------------------------------------------------------- Dated: -------------------___________, ---------- -------------------------------------- Signature __________________ Signature__________________________ Signature(s) Guaranteed: SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Signature must conform in all respects to name of holder as specified on BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO SEC RULE 17Ad−15. _________________ The undersigned hereby certifies that the fact of Rights evidenced by this Rights Certificate) Signature Guaranteed EXHIBIT C FORM OF AMENDED Certificate are not beneficially owned by an Acquiring Person or an Affiliate or Associate thereof (as defined in the Rights Agreement). Signature______________________ 5705655v.4 CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of The undersigned hereby certifies by checking the Delaware General Corporation Law MINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Abraxas Petroleum Corp)

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