Affidavit of Lost, Stolen or Destroyed Stock Certificate

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AFFIDAVIT OF LOST STOCK CERTIFICATE
This Affidavit of Lost Stock Certificate (the “Agreement”) is made and effective this 4th day of April, 2015,
BETWEEN: Weatherman Time, Inc (the 'Company'), a corporation organized and existing under the laws of the Ohio with its head office located at: 20 North Broadway, Suite 1800, Cleveland, Ohio 44113-2241
AND: Jeffrey Jones (the 'Stockholder'), an individual with his main address at: 19th Floor, 1608 Walnut Street, Phoenix, Arizona 85016
TERMS
The undersigned Stockholder hereby declares, under penalty of perjury, as follows:
1. The undersigned is the owner of a total of [NUMBER OF SHARES] shares of the Common Stock of [NAME OF COMPANY], Inc., a [STATE WHERE COMPANY INCORPORATED] corporation (the “Company”).
2. The undersigned has examined his, her or its records and, after diligent search, is unable to find the certificate or certificates representing such shares (the “Certificates”)and believes that the Certificates were lost.
3. The undersigned has not transferred, sold, encumbered, or pledged any of the shares represented by the Certificates.
4. The undersigned releases the Company and any successor from any and all liability relating to the loss of the Certificates, or the issuance of new Certificates. The undersigned agrees to defend and indemnify and hold harmless the Company and any successor from any damage or loss caused by the loss of the Certificates.
5. In the event of discovery of the original Certificates, the undersigned agrees to return them promptly to the Company or any successor, marked “CANCELLED.”
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date first above written.
COMPANY

 
STOCKHOLDER

 
Stephen Cochran
President
Jeffrey Jones


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