GENERAL
PROXY
The
undersigned ________________ (Name), being a stockholder of
____________________ (Name of Corporation) (hereinafter
"Corporation"), does hereby grant and confer power of attorney and
proxy upon ________________ (Name of Person Assigned) to represent the
undersigned at any and all regular and special meetings of the shareholders of
said Corporation. This power of
attorney and proxy shall exist for a duration of time not extending beyond
______________________ (Date).
Said
agent will not be limited in exercising all of the rights and privileges as I
would regularly enjoy as pertains to voting, discussion, or any other matter
arising for consideration and action during business of said meetings, acting
on my behalf.
___________________________________ ________________
Signed
Date
___________________________________ ________________
Witness
Date
