Director’s Proxy

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Director’s Proxy

__________________________, a director of ____________________, herewith appoints and designates as his proxy __________________, for a meeting of the board of directors scheduled for ____________ ________, with the full right and authority to vote in the place of ____________________, provided, however, that there is no right of substitution. Therefore, for attendance and quorum purposes, I should be counted as in attendance.

Dated: ______________________

__________________________________________

Director

___________________________________________

Witness