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If a proxy is
used to cast the ballot, the proxy signs the name of the Shareholder on the first line, then signs
his or her own name on the second line.
__________________<Company Name>____________________
I, the undersigned Shareholder, hereby vote <Number> shares of stock for the following named
persons to serve as Directors for the ensuing term:
_________________________
_________________________
_________________________
_________________________
Date: ______________
_________________________
Shareholder
_________________________
Proxy