PROXY

 

KNOW ALL MEN BY THESE PRESENTS:

 

            That I, ______________________________________________, am a Precinct

                        (Print name of person making the appointment)

 Committeeman from the ___________ Precinct, District 18, in Maricopa County, State of Arizona, and that I do hereby constitute and appoint the following person to carry my proxy:

 

___________________________________              __________________________________

            (Print name of proxy appointee)                                    (Address of appointee)

 

            This proxy appointee is a member of the Republican Party, is a legal and qualified voter in my same precinct, and is hereby appointed as my Attorney- in-Fact and proxy to vote for me, in my name and stead, at the Republican District 18 Meeting, to be held at _________________________________, Mesa, Arizona on ______________ at the hour of _________m, for the transaction of any and all business that may properly come before the meeting, and I do hereby approve, ratify, and confirm all the acts of my named proxy appointee.

 

            Dated this _____ day of ___________________________, 2007

 

 

                                                Signature: _______________________________________

                                                                (Precinct committeeman making the appointment)

______________________________________________________________________________

NOTE: Neither the witness nor the Notary Public may be the proxy appointee. The signature of the Precinct Committeeman who is appointing the proxy MUST be witnessed by two other adult signatures OR be attested to by a Notary Public below.

_____________________________________________________________________________ 

 

 

x__________________________________              x__________________________________

            (Witness other than appointee)                          (Witness other than appointee)

 

State of Arizona            )

                                    ) ss

County of Maricopa     )

 

            Subscribed and sworn to before me this _____day of ________________________, 2007 by ___________________________________.

 

                                                                                    ___________________________________

                                                                                                Notary Public

MY COMMISSION EXPIRES:                                 

 

_______________________________________