L
O A |
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LETTER of
AUTHORIZATION |
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(To transfer
securities or money) |
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Date: |
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Part A: |
(Transfer of Ownership) |
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Certificate(s) to
Certifcate(s) |
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Please
transer the securities listed below: |
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From the registered name of |
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to
the registered name of |
The Athletic Foundation
of the University |
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of North Carolina at
Charlotte, Inc. |
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Part B: |
(Complete appropriate
section(s) below). |
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No.
of Shares |
Name of Security |
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Certificate Number(s) |
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I
hereby finally irrevocably release and discharge you or any claims by me or
my |
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legal
representatives with reference to the foregoing, including the proceeds of |
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sale
or other disposition thereof. |
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Transferor: |
Signature: |
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Signature: |
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Acceptance: |
Signature: |
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Signature: |
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