VIEWS: 4 PAGES: 1 POSTED ON: 6/19/2012
REVOCATION OF PROXY I, , the holder of shares of common voting stock of (Corporation), having appointed to act as my proxy by a written proxy dated , (year), a copy of which is attached, do hereby revoke that proxy. IN WITNESS WHEREOF, I do hereby execute this revocation of proxy in duplicate on this, the day of , (year). The original of this revocation shall be filed in the office of the Corporation, and the duplicate copy of this revocation shall be delivered by Certified Mail, Return Receipt Requested, to , the person named by me as my proxy in the revoked proxy agreement. ___________________________________ STATE OF COUNTY OF } On before me, , personally appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature___________________________ Affiant _____Known _____Unknown ID Produced________________________ (Seal) ZZAAAZAZ
"REVOCATION OF PROXY"