v11.20.12
Fill out the form below and click the Generate Document button at the bottom of the form. Click the Restart button to start over.
1. The name of the Corporation.
2. Address where the annual shareholder meeting was held.
3. Title of the corporate officer calling meeting to order.
4. Name of a shareholder either present at the meeting or represented by proxy.
5. Number of shares owned by the shareholder.
6. If the shares were voted by the shareholder "in person" (rather than by proxy) enter "in person" here.
7. If the shares were voted by the shareholder "by proxy" (rather than in person) enter "by proxy" here.
8. Name of a shareholder either present at the meeting or represented by proxy.
9. Number of shares owned by the shareholder.
10. If the shares were voted by the shareholder "in person" (rather than by proxy) enter "in person" here.
11. If the shares were voted by the shareholder "by proxy" (rather than in person) enter "by proxy" here.
12. Name of a shareholder either present at the meeting or represented by proxy.
13. Number of shares owned by the shareholder.
14. If the shares were voted by the shareholder "in person" (rather than by proxy) enter "in person" here.
15. If the shares were voted by the shareholder "by proxy" (rather than in person) enter "by proxy" here.
16. Name of a shareholder either present at the meeting or represented by proxy.
17. Number of shares owned by the shareholder.
18. If the shares were voted by the shareholder "in person" (rather than by proxy) enter "in person" here.
19. If the shares were voted by the shareholder "by proxy" (rather than in person) enter "by proxy" here.
20. Name of a shareholder either present at the meeting or represented by proxy.
21. Number of shares owned by the shareholder.
22. If the shares were voted by the shareholder "in person" (rather than by proxy) enter "in person" here.
23. If the shares were voted by the shareholder "by proxy" (rather than in person) enter "by proxy" here.
24. Name of a shareholder either present at the meeting or represented by proxy.
25. Number of shares owned by the shareholder.
26. If the shares were voted by the shareholder "in person" (rather than by proxy) enter "in person" here.
27. If the shares were voted by the shareholder "by proxy" (rather than in person) enter "by proxy" here.
28. Name of a shareholder either present at the meeting or represented by proxy.
29. Number of shares owned by the shareholder.
30. If the shares were voted by the shareholder "in person" (rather than by proxy) enter "in person" here.
31. If the shares were voted by the shareholder "by proxy" (rather than in person) enter "by proxy" here.
32. List any changes in stockholders that were made since the last report.
33. List directors nominated and elected to serve until next annual meeting.
34. Enter the name of the Secretary in attendance at the meeting.
