Proxy to Vote Corporate Shares : Please fill out the following form. Please print your completed form if you would to have a copy for your records.
BE IT KNOWN, that the undersigned (stockholder's name) of (stockholder's address) being the owner of 1000 shares of voting common stock of (Corporation) does hereby grant to (Name) a proxy and appoint him my attorney-in-fact to vote on behalf of the undersigned 10000 shares of said stock at any future general or special meeting of the stockholders of the Corporation, and said proxyholder isentitled to attend said meetings and act on my behalf and vote said share personally or throughmail proxy, all to the same extent as if I voted said shares personally.
During the pendency of this proxy, all rights to vote said shares shall be held by theproxyholder with full power of substitution or revocation, provided the undersigned may revokethis proxy at any time, upon written notice of termination by certified mail, return receipt, toboth the proxyholder and to the corporation.
The proxyholder shall be entitled to reimbursement for reasonable expenses incurredhereunder, but otherwise shall not be entitled to compensation for the services to be rendered.
This agreement shall be binding upon and inure to the benefit of the parties, theirsuccessors, assigns and personal representatives.
IN WITNESS WHEREOF, I have executed this proxy this day of (DATE).
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
Proxy to Vote Corporate Shares
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