PLE TRANSFER LEDGER

SAM
Publication No. 2009 EE

Stevens-Ness Law Publishing Co.

Portland, OR 97204 – (503) 223-3137
 NUMBER OF
CERTIFICATE DATA CERTIFICATES TURNED IN SHARES*
DATE DATE VALUE OF ANY
SHAREHOLDERʼS SHAREHOLDERʼS SELLER / TRANSFERING PARTY AMOUNT STILL HELD
SHARES SHARES* BUYER / RECEIVING PARTY TRANSFER TAX
NAME ADDRESS (If Original, Enter “Original Issue”) PAID BY
ACQUIRED CERTIFICATE NO. OF TRANSFERRED CERTIFICATE NO. OF STAMP(S) AFFIXED
NO. SHARES* NO. SHARES* SHAREHOLDERS
(If Any)

E
B

MPL
E

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*If certificates pertain to a limited liability company, read and/or insert units, membership interests or member interests, as appropriate.
 NUMBER OF
CERTIFICATE DATA CERTIFICATES TURNED IN SHARES*
DATE DATE VALUE OF ANY
SHAREHOLDERʼS SHAREHOLDERʼS SELLER / TRANSFERING PARTY AMOUNT STILL HELD
SHARES SHARES* BUYER / RECEIVING PARTY TRANSFER TAX
NAME ADDRESS (If Original, Enter “Original Issue”) PAID BY
ACQUIRED CERTIFICATE NO. OF TRANSFERRED CERTIFICATE NO. OF STAMP(S) AFFIXED
NO. SHARES* NO. SHARES* SHAREHOLDERS
(If Any)

E
I

MPL
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N
SA
*If certificates pertain to a limited liability company, read and/or insert units, membership interests or member interests, as appropriate.
 NUMBER OF
CERTIFICATE DATA CERTIFICATES TURNED IN SHARES*
DATE DATE VALUE OF ANY
SHAREHOLDERʼS SHAREHOLDERʼS SELLER / TRANSFERING PARTY AMOUNT STILL HELD
SHARES SHARES* BUYER / RECEIVING PARTY TRANSFER TAX
NAME ADDRESS (If Original, Enter “Original Issue”) PAID BY
ACQUIRED CERTIFICATE NO. OF TRANSFERRED CERTIFICATE NO. OF STAMP(S) AFFIXED
NO. SHARES* NO. SHARES* SHAREHOLDERS
(If Any)

E
P-Q

MPL
U-W
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X-Z
SA
*If certificates pertain to a limited liability company, read and/or insert units, membership interests or member interests, as appropriate.