PROXY

I/We hereby nominate, constitute and appoint

______________________________________

as my proxy/representative, with right of substitution and revocation, to represent me and

exercise my right to vote for the members of the Board of Directors of the
_______________________ Association, Inc. for 2016-2017, as fully to all intents and
purposes as I/we might or could do if present.

This proxy revokes all proxies which I may have previously executed in favor of a
person or persons other than those named above. This proxy shall be valid only for the election
of the Board of Directors for 2016-2017, until withdrawn by me through notice in writing, or
superseded by subsequent proxy, delivered to the Secretary at least two (2) days before any
scheduled meeting, and shall not apply in instances where I personally attend the
meeting/election.

Executed on __________________ at __________________.

Name of Homeowner/Member
(Signature over Printed Name)

Witness: ______________________