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Back to Forms for 'Power of Attorney'.





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



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