IRREVOCABLE PROXY

I, , the holder of shares of the

common voting stock of
Corporation, do hereby irrevocably appoint
as my proxy to attend the shareholders meeting of
Corporation, to be held on , (year), or any continuations or
adjournments of that meeting, with full power to vote and act for me and in my name and place,
in the same manner, and to the same extent that I might act if I would have been in attendance at
such meeting.
This proxy is irrevocable and has been issued to ,
who is a pledgee holding a valid pledge of the shares owned by me. Any other proxy or proxies
previously given by me to others is hereby revoked.
Date:
___________________________________
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)
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