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General Proxy
GENERAL PROXY
The undersigned of ______________, being a stockholder of
______________________ Inc., does hereby constitute and appoint
as the lawful attorney, agent and proxy of the undersigned the
following named person:__________________ for a period of
______________ from the date hereof, to represent the undersigned
at any and all stockholders meetings of ____________________
Inc., and at any adjournment thereof, within ____________ from the
date hereof, to act for and in the name, place and stead of the
undersigned on all matters and things which may be presented for
action or consideration at such meetings, giving and granting
unto said attorney and proxy as full power in all respects as the
undersigned could exercise if present in person.
The undersigned hereby ratifies all that his attorney and
proxy may or shall lawfully do in voting at any such meetings, or
at any adjournment or adjournments thereof, within the period of
time specified, in respect of all matters, proposals and
questions that may properly come before the stockholders for
consideration and action.
Dated:
________________________________ __________________________
Witness
Form 618
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