Revocation of Proxy

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REVOCATION OF PROXY Date: [DATE] To: The Secretary of [COMPANY NAME] Corporation Subject: Revocation of Proxy The undersigned, the holder of [N] shares of the common stock of [COMPANY NAME] Corporation, hereby revoke a proxy dated [DATE], which was granted to [N]. A duplicate of this Revocation of Proxy has been sent by registered mail to the aforesaid [N], who is the person to whom I originally granted my proxy.

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