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EXHIBIT 4.5
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<S> <C>
Certificate No. _____For _______ Shares Issued to__________Transferred from__________________________________/_________/____________
No. Original Certificate No. Original Shares No. of Shares Transferred
Dated_______________,______ Receipt acknowledged___________________________________________________________________________________
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Transfer Restricted - See Reverse Side Hereof
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NUMBER INCORPORATED UNDER THE LAWS OF SHARES
0 0.00
Delaware
TRAVELCENTERS OF AMERICA, INC.
Common Shares, par value $.00001 per share
This Certifies that SPECIMEN is the owner of ZERO and 00/100 fully paid
and non-assessable Shares of the Capital Stock of the above named Corporation
transferable only on the books of the Corporation by the holder hereof in person
or by duly authorized Attorney upon surrender of this Certificate properly
endorsed.
In Witness Whereof, the said Corporation has caused this Certificate to
be signed by its duly authorized officers and its Corporate Seal to be hereunto
affixed this ______________ day of ______________ A.D._______
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Secretary President
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EXPLANATION OF ABBREVIATIONS
The following abbreviations, when used in the inscription of ownership
on the face of this certificate, shall be construed as if they were written
out in full according to applicable laws or regulations. Abbreviations, in
addition to those appearing below, may be used.
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<S> <C> <C> <C>
JT TEN As joint tenants with right of survivorship and TEN ENT As tenants by the entireties
not as tenants in common UNIF GIFT MIN ACT Uniform Gifts to Minors Act
TEN COM As tenants in common CUST Custodian for
For Value Received, _________________________________________________________ hereby sell, assign and transfer unto
PLEASE INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING NUMBER OF ASSIGNEE
________________________________________________________________________________
Shares represented by the within Certificate, and do hereby irrevocably constitute and appoint
__________________________________ Attorney to transfer the said Shares on the books of the within named
Corporation with full power of substitution in the premises.
Dated _______________________________
In presence of
_____________________________________ _________________________________________
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CERTIFICATE
FOR
____________
SHARES
OF
TRAVELCENTERS OF
AMERICA, INC.
ISSUED TO
SPECIMEN
DATED
_____________________
