The X. Y. Trust Company,

-----------------------9. ............................... •

Depositary for A. B., €. D. and E. F., trustees for stockholders of the G. H. Company.

The undersigned, holder of the certificates of the capital stock of the G. H. Company listed below, hereby deposits the same' with said trustees, duly assigned to said trustees, to be exchanged for certificates of deposit issued by said the X. Y. Trust Company, on behalf of said trustees, for the purposes and subject to the terms and conditions endorsed hereon, and also endorsed on said certificates of deposit.

Number of stock certificate

Date of Issue

Name of person to whom issued

(Signature of depositor) ---------.

(Address) ---------.

---------,---------, 19-.

See references under Sec. 3840.

For the validity of voting trusts, see 9 887.