SERIES B CERTIFICATE OF INDEBTEDNESS
No. ________________ $________________
CORNERSTONE MINISTRIES INVESTMENTS, INC. ("ISSUER") promises to pay to
______________________________________________________ or registered
assigns, the principal sum of
________________________________________ Dollars ($__________).
Taxpayer I.D. Number: _________________ CUSIP Number:_________________.
SERIES A CERTIFICATES OF INDEBTEDNESS
Payment Dates:______________ and ________________.
Record Dates:_______________ and ________________.
Maturity Date:______________
Interest Rate:______________
Dated:_________________, 2000
__________________________, as CORNERSTONE MINISTRIES
Trustee, certifies that this is INVESTMENTS, INC.
one of the Certificates
referred to in the Trust
Indenture.
By:____________________________ By:__________________________
▇▇▇▇▇ ▇. ▇▇▇▇▇▇, President
Name:__________________________
Attest:_______________________
Title:_________________________ ▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇, Secretary
[SEAL] [SEAL]
Exhibit 4.3
The registered owner of this Certificate shall be entitled to all the rights and
privileges and subject to the conditions, limitations and agreements set forth
in the Trust Indenture executed in connection with the offering of the
securities described on the front side of this Certificate, the terms,
covenants, conditions and agreements of such Trust Indenture being incorporated
herein by this reference.
The Issuer will furnish to any Certificate owner upon written request and
without charge a copy of the Trust Indenture. Requests may be made to ▇▇▇▇ ▇.
▇▇▇▇▇▇▇▇, Cornerstone Ministries Investments, Inc., ▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇,
▇▇▇▇▇ ▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇-▇▇▇▇.
Abbreviations. Customary abbreviations may be used in the name of a Certificate
owner or an assignee, such as TEN COM (=tenants in common), TEN ENT (=tenants by
the entireties), JT TEN (= joint tenants with rights of survivorship and not as
tenants in common), CUST (= Custodian), and U/G/M/A (- Uniform Gifts to Minors
Act).
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SECURITY POWER FORM:
THE FOLLOWING MUST BE COMPLETED TO TRANSFER YOUR CERTIFICATE TO ANOTHER
For value received I/We hereby sell, assign and transfer unto
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(Name and address of Transferee must be printed or typed)
----------------------------------------------- ------/-----/-------
City State Zip Code Social Security Number
all right, title and interest to this Series B Certificate of Indebtedness,
including all outstanding principal and accrued interest, and do hereby
irrevocably constitute and appoint the Registrar to transfer the said
Certificate on the books of the within named Issuer, with full power of
substitution in the premises and to issue a new Certificate to the Transferee
(New Owner). The Social Security Number of the Transferee (New Owner) his/her
name and mailing address where he/she wishes to receive interest checks or
notices must be provided to the Registrar along with the transfer fee BEFORE
TRANSFER can be completed. The transfer request must be received 15 calendar
days prior to an interest payment date.
If Joint Ownership, Both Must Sign Certificate
Date:____________, ___ ______________________________________________
Signed (Registered Owner as Shown on Front)
In the presence of:
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Authorized Signature Guarantee Signed (Registered Owner as Shown on Front)
Above Signatures must be guaranteed (not notarized) by a participant in a
Medallion Guarantee Program.
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New Owner - Please check this form for accuracy before you sign. Your
Certificate will be registered exactly as shown. You will be charged a fee per
Certificate if you require further changes. You must sign below to verify your
Social Security Number. Please provide your daytime telephone number (___)
_____-______________.
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Please send me/us a confirmation and retain Certificate.
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Under penalties of perjury, I certify (1) that the number shown on this form is
my correct taxpayer identification number, and (2) that I am not subject to
backup withholding because: (a) I have not been notified that I am subject to
backup withholding as a result of failure to report all interest or dividends,
or (b) the Internal Revenue Service has notified me that I am no longer subject
to backup withholding.
_______________________________________________ SS#_________-_______-______
Signature of Transferee whose number is shown Date:___________________
at right (or)
_______________________________________________ TIN#_________-_______-_____
Signature of Authorized Signer for Transferee Date:___________________