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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)___, 19(8).

____________(9)_________________ _____________(10)______________

____________(9)_________________

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.