Fill and Sign the Of Shareholders on the Day of 20 at Form

- 1 - MINUTES OF SPECIAL MEETING OF SHAREHOLDERS OF ____________________________________ The shareholders of ___________________________________ held a Special Meeting of Shareholders on the ____ day of _________, 20__ at ___________ __.m., at ____________________________. The meeting was called to order at ___________ __.m. by _______________________, President, who chaired the meeting, and ______________ kept the record of the meeting. The following stockholders were present in person: _________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ A total of ___________ shareholders representing _____% of the shares outstanding were not represented at the stockholder's meeting. The shares represented in person were _____% of the total shares outstanding. The shares represented by proxy were ______% of the total shares outstanding. A total of ________% of the outstanding shares were represented at the special stockholder's meeting. The President of this corporation served as Chairman and called the meeting to order, and announced that a quorum was present and that this meeting was held pursuant to a written notice of special meeting given to all shareholders of this corporation. A copy of this notice was ordered inserted in the minute book immediately preceding the minutes of this meeting. On motion duly made and seconded, the following business came before the shareholders: [Insert a record of all business transacted, for example, vote for amendment to Articles or Bylaws. Note: All actions taken at the Annual or Special Meeting of Shareholders should be recorded in the minutes of the meeting.] - 2 - ADJOURNMENT There being no further business to come before this meeting, on motion duly made, seconded, and carried, this meeting was adjourned. IN WITNESS WHEREOF, I have executed my name as Secretary and have hereunto affixed the corporate seal of the above-named Corporation this ____ day of _________, 20__. _______________________________ Secretary (SEAL)