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Important
Note:
Forms are to be used as a guide only to assist you. No liability is assumed for errors in substance or form. It is your responsibility to revise the forms to meet current law
requirements and your particular situation. No liability is assumed for improper use of these forms.
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PROXY
BE IT KNOWN,
that I, ________________, the undersigned Shareholder of
_________________,
a ____________ corporation, hereby constitute and appoint
_____________________
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
_________________ 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 ____ day of _________, 19(8).
_______________________________
_____________________________
_______________________________
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