Proxy

10/14/2013

BE IT KNOWN, that I, ________(1)________, the undersigned
Shareholder of ________(2)_______, a _____(3)_____
corporation, hereby constitute and appoint
__________(4)_________ as my true and lawful attorney and
agent for me and in my name, place and stead, to vote as my
proxy at the Meeting of the Shareholders of the said
corporation, to be held on _______(5)________ or any
adjournment thereof, for the transaction of any business which
may legally come before the meeting, and for me and in my
name, to act as fully as I could do if personally present; and
I herewith revoke any other proxy heretofore given.

WITNESS my hand and seal this _(6)_ day of ____(7)___, 20
__(8)__.

___________(9)______________   ___________(10)___________

___________(9)______________

Notice

The information in this document is designed to provide an outline that you can follow when formulating business or personal plans. Due to the variances of many local, city, county and state laws, we recommend that you seek professional legal counseling before entering into any contract or agreement.

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