Fill and Sign the Irrevocable Proxy Form

Irrevocable Proxy BE IT KNOWN, that for good consideration, the undersigned, being the owner of _______ (number) shares of voting stock of _________________________ (Name of Corporation) , hereinafter called the Corporation , hereby grant to _________________ (Name) , a non-revocable proxy to vote on behalf of the undersigned ______ (number) shares of the said stock at any future meeting of the stockholders of the Corporation, and the said proxy holder is entitled to attend the said meetings on my behalf or vote the said shares through mail proxy. During the pendency of this proxy, the rights to vote the said shares shall be exclusively held by the proxy holder and shall not be voted by the undersigned. This proxy shall not be revocable and shall remain in effect until ______________ (date) , when all rights hereunder shall terminate. The undersigned agrees to annex a legend to say the shares stating the existence of this outstanding proxy, as all rights hereunder shall survive any sale or transfer of the said shares. IN WITNESS WHEREOF I have hereunto set my hand and seal on the ____ day of ____________, 20______. _________________________ (Printed Name of Shareholder) _________________________ (Signature of Shareholder) This instrument was, on the date shown above, signed, published and declared by _________________________ (Name of Shareholder) to be an Irrevocable Proxy, in our presence, and we, at his request, have subscribed our names hereto as witnesses in his presence and in the presence of each other. _______________________________________ ____________________________________________ WITNESSES