Other, no date

UNITED STATES RADIUM CORPORATION The undersigned, being the registered ouner of the number of abares hereinbelow set opposite his asme of the 87 vo Praference Stock of United States Reditma Corgoration (the naze of such stoek having been changed to the above name from its former nime @7 Cummlative Prior Proference Stock, by anendment filed with the Secretary of State of on June 11, 1929, which said stock created by filed with the Secrotery of State of Dolewore on karch 5, 1929, by reclass fication, anare for ahare, of the then existing cosvertible seven per dent. cumulative preferred stock of said Corporat on), pursuant to a certain plon for the readjustment of the capitel structore of the Corporation, duly adopted by the stockholders of the Corporation at a special meeting hold on June 4, 1920 and adjourned to June 10,1029, hereby surrenders to psid Corporation the cert ficates representing such ahores (auch certifieates being certifiontes for the said convertible seven per cent. cumulative preferred stock) and does hereby release and surrender all rights to any and all unpaid cumulative dividends now accrued or which any heronfter accrue on said $7 Cumulativo Proference Stocit or on seid (7 Comulative Prior Proference Stock and on all ahares of sald convertible soven per cent. cumilative preferred stock which reclessi- fiod into the seme as sforesaid, and also on any and all other shores of any of such stock shich may be owned by the undersigned: Name of Stockholder Number of Shares