CORPORATE PROXY
________ (the "Corporation")
________ ("Stockholder"), the undersigned, having an address at the following:
________
hereby designates the following individual as true and lawful proxy ("Proxy") for the Stockholder with the full power of substitution to represent Stockholder and vote all of Stockholder's shares with respect to the Corporation: ________.
Such Proxy shall be valid at the meeting on the following date: ________. This meeting is the annual meeting of the Corporation.
By this designation of Proxy, the Stockholder hereby revokes any and all prior proxy designations which may have been made with respect to the Stockholder's shares.
The Proxy shall have full power as the Stockholder's proxy to vote any issue, motion or action that the Stockholder may have voted and to otherwise represent the Stockholder with respect to the corporation.
The Proxy may vote at the Proxy's sole and exclusive discretion, except with regard to the following:
________
EXECUTION:
Name of Stockholder: ________
_____________________________
Signature
_____________________________
Date
(notary page follows)
State of Alabama
County of: ______________________________
On this _____ day of ________________________________________, 20__, before me, personally appeared _____________________________________________, to me known to be the person described in and who executed the foregoing instrument, 525 582228825225 2552 2522 25285225 82 58 25285 2522 582 525 5225.
__________________________________________________________________
Notary Signature, Printed Name, and Notary/Bar Roll Number
CORPORATE PROXY
________ (the "Corporation")
________ ("Stockholder"), the undersigned, having an address at the following:
________
hereby designates the following individual as true and lawful proxy ("Proxy") for the Stockholder with the full power of substitution to represent Stockholder and vote all of Stockholder's shares with respect to the Corporation: ________.
Such Proxy shall be valid at the meeting on the following date: ________. This meeting is the annual meeting of the Corporation.
By this designation of Proxy, the Stockholder hereby revokes any and all prior proxy designations which may have been made with respect to the Stockholder's shares.
The Proxy shall have full power as the Stockholder's proxy to vote any issue, motion or action that the Stockholder may have voted and to otherwise represent the Stockholder with respect to the corporation.
The Proxy may vote at the Proxy's sole and exclusive discretion, except with regard to the following:
________
EXECUTION:
Name of Stockholder: ________
_____________________________
Signature
_____________________________
Date
(notary page follows)
State of Alabama
County of: ______________________________
On this _____ day of ________________________________________, 20__, before me, personally appeared _____________________________________________, to me known to be the person described in and who executed the foregoing instrument, 525 582228825225 2552 2522 25285225 82 58 25285 2522 582 525 5225.
__________________________________________________________________
Notary Signature, Printed Name, and Notary/Bar Roll Number
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