Free Shareholder Proxy

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Shareholder Proxy

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Ohio

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SHAREHOLDER PROXY

To: ___________________________ (the "Corporation"), a corporation incorporated under the laws of The State of Ohio.

I, ___________________________ (the "Nominor"), owning and holding ____ ___________________________ shares of the capital stock of the Corporation, HEREBY APPOINT ___________________________ as my proxyholder (the "Proxy") to attend and act at the special shareholder meeting of the Corporation to be held on the ________ day of ________________, ________, and at any adjournment or adjournments of that meeting in the same manner, to the same extent and with the same power as if the Nominor was present at the said meeting or such adjournment or adjournments of that meeting.

The Proxy has full authority to vote at the Proxy’s own discretion on all matters and issues, except as follows: ____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________.

DATED this ________ day of ________________, ________.

 

________________________________

 

___________________________



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