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SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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AMENDMENT NO. 1
TO
FORM 8-A
FOR REGISTRATION OF CERTAIN CLASSES OF SECURITIES
PURSUANT TO SECTION 12(b) OR 12(g) OF THE
SECURITIES EXCHANGE ACT OF 1934
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STAFF BUILDERS, INC.
(Exact Name of Registrant as Specified in its Charter)
DELAWARE 13-3139732
(State of Incorporation (I.R.S. Employer
or Organization) Identification Number)
1983 MARCUS AVENUE
LAKE SUCCESS, NEW YORK 11042
(Address of principal executive offices) (Zip code)
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If this Form relates to the registration of a class of debt securities and is
effective upon filing pursuant to General Instruction A(c)(1) please check the
following box./ /
If this Form relates to the registration of a class of debt securities and is to
become effective simultaneously with the effectiveness of a concurrent
registration statement under the Securities Act of 1933 pursuant to General
Instruction A(c)(2) please check the following box. / /
Securities to be registered pursuant to Section 12(b) of the Act:
Name of Each Exchange
Title of Each Class on Which Each Class
to be so Registered is to be Registered
NONE NONE
Securities to be registered pursuant to Section 12(g) of the Act:
CLASS A COMMON STOCK, $0.01 PAR VALUE
(Title of class)
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THE PURPOSE OF THIS AMENDMENT IS TO AMEND THE FORM OF SPECIMEN
CERTIFICATE FOR THE CLASS A COMMON STOCK AS SET FORTH IN EXHIBIT 1 HERETO.
Item 2. Exhibits
EXHIBITS
1. Form of Specimen Certificate of the Class A Common Stock.
INDEX TO EXHIBITS
1. Form of Specimen Certificate of the Class A Common Stock.
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SIGNATURE
Pursuant to the requirements of Section 12 of the Securities Exchange
Act of 1934, the registrant has duly caused this Amendment No. 1 to this
registration statement to be signed on its behalf by the undersigned,
thereto duly authorized.
STAFF BUILDERS, INC.
Date: October 24, 1995
By: /s/ Stephen Savitsky
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Stephen Savitsky
Chief Executive Officer and President
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FRONT OF FORM OF STOCK CERTIFICATE
LOGO
STAFF BUILDERS, INC.
INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE
NUMBER SHARES
CLASS A COMMON STOCK --- SEE REVERSE FOR CERTAIN DEFINITIONS
CUSIP
THIS CERTIFIES THAT _________________ is the owner of ___________ FULLY PAID AND
NON-ASSESSABLE SHARES, $.01 PAR VALUE, OF THE CLASS A COMMON STOCK OF STAFF
BUILDERS, INC. transferable on the books of the Corporation by the holder
hereof in person or by duly authorized attorney upon surrender of this
certificate properly endorsed. This Certificate and the shares represented
hereby are issued and shall be subject to all of the provisions of the
Certificate of Incorporation, as amended, of the Corporation (a copy of which
is on file at the office of the Corporation) to all of which the holder of this
certificate, by acceptance hereof assents. This Certificate is not valid until
countersigned and registered by the Transfer Agent and Registrar.
Witness the facsimile seal of the Corporation and the facsimile signatures of
its duly authorized officers.
Dated:
SEAL
/s/ David Savitsky /s/ Stephen Savitsky
Secretary President
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BACK OF FORM OF STOCK CERTIFICATE
A FULL STATEMENT OF THE DESIGNATIONS, PREFERENCES, AND RELATIVE, PARTICIPATING,
OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OF THE CORPORATION OR
SERIES THEREOF AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH
PREFERENCES AND/OR RIGHTS WILL BE FURNISHED BY THE CORPORATION, WITHOUT CHARGE,
TO EACH STOCKHOLDER WHO SO REQUESTS, UPON APPLICATION TO THE TRANSFER AGENT OR
TO THE SECRETARY OF THE CORPORATION.
The following abbreviations, when used in the inscription on the face of this
certificate, shall be construed as though they were written out in full
according to applicable laws or regulations:
TEN COM -- as tenants in common UNIF GIFT MIN. ACT-- _______ Custodian
TEN ENT -- as tenants by the entireties (Cust) (Minor)
JT TEN--as joint tenants with right of Under Uniform Gifts to Minors Act
survivorship and not as tenants in common _________________________________
(State)
Additional abbreviations may also be used though not in the above list.
For value received, _____ hereby sell, assign and transfer unto _________
PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE
(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, OF ASSIGNEE)
Shares of the capital stock represented by the within Certificate, and do hereby
irrevocably constitute and appoint __________ Attorney to transfer the said
stock on the books of the within named Corporation with full power of
substitution in the premises.
Dated _____________________________
NOTICE: The Signature To This Assignment Must Correspond With The Name As
Written Upon The Face Of The Certificate In Every Particular Without Alteration
Or Enlargement Or Any Change Whatever
