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Back to Forms for 'Power of Attorney'.





For payment of one dollar ($1), I hereby bestow upon __________________________ (Name of Proxy) proxy to vote  ________________________________ (Name of Shareholder) shares of stock of ________________________________ (Name of Corporation) (hereinafter "Corporation") on my behalf at the shareholders' meeting of said Corporation, which will be held ________________________ (Date).  The proxy is conferred in consideration of the following conditions:


FIRST:  Said person shall have all the power to vote and attend the aforesaid meeting as I currently enjoy.


SECOND:  This proxy, which may not be revoked by myself, nor my heirs or assigns, shall not last for a period beyond the above noted shareholders' meeting, or any extension thereof.




___________________________________                       _________________

Signed                                                                                   Date



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