Irrevocable Proxy : Please fill out the following form. Please print your completed form if you would to have a copy for your records.
I (Stockholder's name) the holder of (Number of shares) shares of the common voting stock of (Company's name) Corporation, do hereby irrevocably appoint (Name of The appointed person)as my proxy to attend the shareholder’s meeting of (Company's name) Corporation, to be held on (year) or any continuations oradjournments of that meeting, with full power to vote and act for me and in my name and place, in the same manner, and to the same extent that I might act if I would have been in attendance atsuch meeting.
This proxy is irrevocable and has been issued to (Name of The appointed person) who is a pledgee holding a valid pledge of the shares owned by me. Any other proxy or proxies previously given by me to others is hereby revoked.
STATE OF :
COUNTY OF :
On _________________________ before me ________________________ personally appeared ___________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Affiant : Known / Unknown
ID Produced :
Affidavits Forms Index
to HOME PAGE