F&M BANK CORP
DEFR14A, 1998-03-13
STATE COMMERCIAL BANKS
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                                  SCHEDULE 14A
                                 (Rule 14a-101)
                     Information Required in Proxy Statement

                            SCHEDULE 14A INFORMATION
                Proxy Statement Pursuant to Section 14(a) of the
                         Securities Exchange Act of 1934
                                (Amendment No. )

Filed by the Registrant [X] 
Filed by a Party other than the Registrant [ ]

Check the appropriate box:
<TABLE>
<CAPTION>
<S>                                                <C>
[ ]  Preliminary Proxy Statement                   [ ]  Confidential, For Use of the Commission  
                                                        Only (as permitted by Rule 14a-6(e)(2))
[X]  Definitive Proxy Statement
[ ]  Definitive Additional Materials
[ ]  Soliciting Material Pursuant to Rule 14a-
     11(c) or Rule 14a-12
</TABLE>

                                F & M BANK CORP.
- --------------------------------------------------------------------------------
                (Name of Registrant as Specified in Its Charter)

- --------------------------------------------------------------------------------
    (Name of Person(s) Filing Proxy Statement, if Other Than the Registrant)

Payment of Filing Fee (Check the appropriate box):

[X]  No fee required.

[ ]  Fee computed on table below per Exchange Act Rules 14a-6(i)(1) and 0-11.

     (1)   Title of each class of securities to which transaction applies:
           .....................................................................
     (2)   Aggregate number of securities to which transaction applies:
           .....................................................................
     (3)   Per unit  price or other  underlying  value of  transaction  computed
           pursuant to Exchange Act Rule 0-11 (set forth the amount on which the
           filing fee is calculated and state how it was determined):
           .....................................................................
     (4)   Proposed maximum aggregate value of transaction:
           .....................................................................
     (5)   Total fee paid:
           .....................................................................

[ ]  Fee paid previously with preliminary materials.
           .....................................................................

[ ]  Check box if any part of the fee is offset as provided by Exchange Act Rule
     0-11(a)(2)  and identify the filing for which the  offsetting  fee was paid
     previously.  Identify the previous filing by registration statement number,
     or the form or schedule and the date of its filing.

     (1)   Amount previously paid:
           .....................................................................
     (2)   Form, Schedule or Registration Statement no.:
           .....................................................................
     (3)   Filing Party:
           .....................................................................
     (4)   Date Filed:
           .....................................................................

<PAGE>

                                F & M BANK CORP.
                              Timberville, Virginia

                    Notice of Annual Meeting of Shareholders
                     To the Shareholders of F & M Bank Corp.

         The annual meeting of  shareholders  of F & M Bank Corp.  (the Company)
will be held on Saturday, April 11, 1998, at 5:30 P.M. at the McGaheysville Fire
Department  Activity  Building,  McGaheysville,   Virginia,  for  the  following
purposes:

         1.   Election of four directors for three-year terms expiring in 2001.

         2.   Ratification of the appointment of S. B. Hoover & Company,  L.L.P.
              as independent auditors for 1998.

         3.   Amendment  of  the  Articles  of  Incorporation  to  increase  the
              authorized  common stock of the Company from  2,000,000  shares to
              3,000,000 shares.

         4.   Transaction of such other business as may properly come before the
              meeting. Management is not aware of any other business, other than
              procedural matters incident to the conduct of the Annual Meeting.

         Only  shareholders  of record at the close of business on February  27,
1998  are  entitled  to  notice  of and to vote  at the  annual  meeting  or any
adjournments thereof.

         To assure  that your  shares are  represented  at the  annual  meeting,
please  complete,  date and sign the  enclosed  proxy,  and return it as soon as
possible in the enclosed postage prepaid envelope.  You may revoke your proxy at
any time prior to its exercise.

                                              By Order of the Board of Directors



                                              Larry A. Caplinger, Secretary

March 13, 1998

<PAGE>

                                F & M BANK CORP.
                                 P. O. Box 1111
                           Timberville, Virginia 22853

                                 PROXY STATEMENT

         This Proxy Statement is furnished in connection  with the  solicitation
of proxies  for use at the annual  meeting of  shareholders  of F & M Bank Corp.
(the  Company)  to be  held  Saturday,  April  11,  1998  at  5:30  P.M.  at the
McGaheysville Fire Department Activity Building, McGaheysville, Virginia, and at
any adjournments  thereof (the Annual Meeting).  The principal executive offices
of the Company are located on Main  Street,  Timberville,  Virginia  22853.  The
approximate  mailing date of this Proxy Statement and the accompanying  proxy is
March 13, 1998.

         The  accompanying  proxy is  solicited by the Board of Directors of the
Company (the Board).  The cost of the  solicitation  of proxies will be borne by
the  Company.  Solicitations  will be made only by the use of the  mail,  except
that, if necessary, officers, directors and regular employees of the Company, or
its affiliates, may make solicitations of proxies by telephone,  telegraph or by
personal  calls.  Brokerage  houses and nominees may be requested to forward the
proxy solicitation material to the beneficial owners of the stock held of record
by such  persons,  and the  Company  may  reimburse  them for their  charges and
expenses in this regard.

         All properly executed proxies  delivered  pursuant to this solicitation
will be voted at the Annual Meeting in accordance with any instructions thereon.
Any person signing and mailing the enclosed proxy may, nevertheless,  revoke the
proxy at any time prior to the  actual  voting  thereof  by (i)  filing  written
notice thereof with the Secretary of the Company (Larry A. Caplinger, Secretary,
F & M Bank Corp., P. O. Box 1111, Timberville,  Virginia 22853); (ii) submitting
a duly executed  proxy  bearing a later date;  or (iii)  appearing at the Annual
Meeting or any adjournment thereof and giving the Secretary notice of his or her
intention to vote in person.

         An  Annual  Report  to  shareholders,   including   current   financial
statements, is being mailed to the Company's shareholders concurrently with this
Proxy Statement, but is not part of the proxy solicitation materials.

         Interested  shareholders  may  obtain,  without  charge,  a copy of the
Company's Form 10-KSB for the fiscal year ended December 31, 1997, as filed with
the  Securities  and  Exchange  Commission,  upon  written  request  to Larry A.
Caplinger,  Secretary, F & M Bank Corp., P. O. Box 1111,  Timberville,  Virginia
22853.


                      OUTSTANDING SHARES AND VOTING RIGHTS

         Only  shareholders  of record at the close of business on February  27,
1998 will be entitled to vote at the Annual  Meeting.  As of February  27, 1998,
the Company had  outstanding  818,654  shares of its common stock,  $5 par value
(Common Stock),  each of which is entitled to one vote at the Annual Meeting.  A
majority  of votes  entitled  to be cast on  matters  considered  at the  Annual
Meeting  constitutes a quorum.  If a share is represented for any purpose at the
Annual  Meeting,  it is deemed to be present  for  purposes  of  establishing  a
quorum.  Abstentions  and  shares  held of record  by a broker  or its  nominees
(Broker  Shares) which are voted on any matter are included in  determining  the
number of votes present or represented at the Annual Meeting. Conversely, Broker
Shares  that are not voted on any matter  will not be  included  in  determining
whether  a quorum is  present.  If a quorum is  established,  directors  will be
elected by a plurality of the votes cast by  shareholders at the Annual Meeting.
Votes that are withheld and Broker  Shares that are not voted in the election of
directors will not be included in determining the number of votes cast.



                                       1
<PAGE>

                        SECURITY OWNERSHIP OF MANAGEMENT

         The following  table sets forth the number and  percentage of shares of
Common  Stock  beneficially  owned,  as of  February  27,  1998  by  each of the
Company's  directors  and  nominees  and  all of  the  Company's  directors  and
executive  officers  as a group.  For the  purposes  of this  table,  beneficial
ownership has been  determined in accordance  with the  provisions of Rule 13d-3
under the  Securities  and Exchange  Act of 1934,  as amended,  under which,  in
general,  a person is deemed to be a beneficial owner of a security if he has or
shares the power to vote or direct the  voting of the  security  or the power to
dispose of or direct the disposition of the security,  or if he has the right to
acquire beneficial ownership of the security within 60 days.

                                       Amount Beneficially            Percent of
Name of Owner                                 Owned                      Class
- --------------------------------------------------------------------------------

Thomas L. Cline                               2,317 1                    .283%

Julian D. Fisher                             29,479 2                   3.601%

Robert L. Halterman                           9,616                     1.175%

Lawrence H. Hoover, Jr.                      15,644 3                   1.911%

Wayne L. Long                                 5,538 4                    .676%

Richard S. Myers                              3,890 5                    .475%

Michael W. Pugh                                 200                      .024%

Dan B. Todd                                  11,842 6                   1.447%

Ronald E. Wampler                             2,500                      .305%

Directors and executive officers
  as a group (9 persons)                     81,026                     9.897%
__________________________________

       1 Includes 1,241 shares owned  directly,  1,020 shares owned jointly with
       another  member of his household and 56 shares owned by another member of
       his household.

       2 Includes 3,143  shares  owned  directly,  2,730 shares owned by another
       member of his household  and 23,606  shares owned by the Company's  stock
       bonus plan over which Mr. Fisher has voting power.

       3 Includes  10,280  shares  owned  directly,  46 shares  owned by another
       member of his  household and 5,318 shares owned by a Unitrust in which he
       is one of the trustees.

       4 Includes 1,742 shares owned  directly and 3,796 shares owned by another
       member of his household.

       5 Includes  1,600  shares  owned  directly  and 2,290  shares held in Mr.
       Myers' IRA Account.

       6 Includes 1,280  shares  owned  directly,  8,554 shares owned by another
       member of his household and 2,008 shares held in Mr. Todd's IRA Account.

                     SECURITY OWNERSHIP OF BENEFICIAL OWNERS

         Management  of the  Company  knows  of no  person  who  has  beneficial
ownership of 5% or more of outstanding Common Stock as of February 27, 1998.



                                       2
<PAGE>

PROPOSAL ONE                  ELECTION OF DIRECTORS

         The term of office for the  current  Class B  directors  expires at the
Annual  Meeting.  The Board of Directors has nominated  such  directors,  namely
Thomas L.  Cline,  Robert L.  Halterman,  Wayne L. Long and  Michael W. Pugh for
reelection,  for a three-year  term, by the  shareholders at the Annual Meeting.
The  persons  named  as  proxies  in the  accompanying  form  of  proxy,  unless
instructed otherwise,  intend to vote for the election of each of these nominees
for directors.  If any nominee should become unavailable to serve, the proxy may
be voted for the election of a substitute  nominee  designated by the Board. The
Board has no reason to believe that any of the nominees  will be unable to serve
if elected.

                  The Board recommends election of the Class B
              director nominees set forth in this Proxy Statement.


                  INFORMATION CONCERNING DIRECTORS AND NOMINEES

         The following  information,  including the principal  occupation during
the past five  years,  is given with  respect to the  nominees,  all of whom are
current directors,  for election to the Board at the Annual Meeting,  as well as
all directors continuing in office.


- --------------------------------------------------------------------------------
Name, Age and Position      Director      Principal Occupation During
with the Company             Since        the Last Five Years
- --------------------------------------------------------------------------------

                                Director Nominees
                                -----------------

                                CLASS B DIRECTORS
            (to serve until the 2001 annual meeting of shareholders)

Thomas L. Cline (51)          1991        President of Truck & Equipment Corp. &
                                          Mac Lease,  Inc. since May 1997,  Sec.
                                          of North and South Lines,  Inc.  since
                                          May 1997,  Secretary  of Truck  Thermo
                                          King, Inc. and Transport Repairs, Inc.
                                          since 1974

Robert L. Halterman (62)      1980        President of Virginia Classic Mustang,
                                          Inc., an auto parts company,  Partner,
                                          H & H Properties

Wayne L. Long (68)            1985        Real estate and retired farmer

Michael W. Pugh (43)          1994        President  of  Old  Dominion   Realty,
                                          Inc., Partner in Tri-City  Development
                                          Co.,  President of Colonial  Appraisal
                                          Service,  Inc.  and  Treasurer  of Old
                                          Mill Enterprises, Inc.

                         Directors Continuing in Office
                         ------------------------------

                                CLASS C DIRECTORS
            (to serve until the 1999 annual meeting of shareholders)

Julian D. Fisher (57)         1990        CEO of Farmers &  Merchants  Bank (the
President & CEO                           Bank) since May 1996; President of the
                                          Bank since Oct. 1991

Dan B. Todd (66)              1969        CEO of the Bank from 1969 to May 1996;
                                          Chairman  of the  Board  of  the  Bank
                                          since Oct. 1991



                                       3
<PAGE>

                                CLASS A DIRECTORS
            (to serve until the 2000 annual meeting of shareholders)

Lawrence H. Hoover, Jr. (63)  1981        Attorney,  Partner in Hoover,  Penrod,
Vice Chairman of the Board                Davenport & Crist and its  predecessor
                                          since 1971

Richard S. Myers (50)         1988        President of Dick Myers  Chevrolet-GEO
                                          since  February  1991,  Owner,  TrAndy
                                          Apartments,  L.L.C.  and  TrAndy  Real
                                          Estate Holdings, L.L.C.

Ronald E. Wampler (50)        1991        Farmer & partner in Dove  Farms,  Inc.
                                          and its affiliates

Board Meetings and Committees

         The  Board of the  Company  met 18 times  during  1997.  All  incumbent
members of the Board  attended  at least 75% of the total  number of meetings of
the Board.  The Board of the Bank meets twice each month and  primarily  manages
all matters for the Bank. All the directors of the Company are also directors of
the Bank.

         The  Company  has an  Audit  Committee  which  reviews  the  audit  and
examination reports of the internal auditor,  independent public accountants and
bank examiners as they relate to the Company and the Bank.  The Audit  Committee
held four  meetings  during 1997.  The present  committee  members are Directors
Cline, Halterman,  Long and Myers. For the year 1997, the Company did not have a
standing nominating or compensation committee.

Compensation of Directors

         All  directors  of the Company who are also  directors of the Bank each
received  $150 for  attending  each  board  meeting  of the  Bank in 1997.  They
received no  additional  compensation  as  directors  for Board  meetings of the
Company.  In  addition,  each  director  received a bonus of $5,000 for the year
ended 1997 and $50 for each committee meeting attended.


                              SUMMARY COMPENSATION

         The Summary Compensation Table below sets forth the compensation of the
Company's Chief Executive  Officer for all services  rendered to the Company and
the Bank for the last three fiscal years.

                           SUMMARY COMPENSATION TABLE
<TABLE>
<CAPTION>

    Name and                                          Annual Compensation 1                 Other
Principal Position                 Year            Salary ($)        Bonus ($)        Compensation ($) 2
- --------------------------------------------------------------------------------------------------------
<S>                                <C>             <C>               <C>                   <C>    
Julian D. Fisher                   1997            $100,000          $35,000               $31,082
 Chief Executive Officer           1996              84,912           30,000                20,813
 & President                       1995              72,800           25,000                17,213
</TABLE>

         1 The value of perquisites  and other personal  benefits did not exceed
the lessor of $50,000 or 10% of the total of annual salary and bonus.

         2 The amounts  presented  include the  Company's  contribution  for the
benefit of Mr. Fisher under the Company's  Stock Bonus Plan  ($14,486,  $12,151,
and  $9,280 in 1997,  1996,  and 1995,  respectively),  the gross  value of life
insurance premiums paid by the Company on behalf of Mr. Fisher ($14,796, $7,334,
and  $7,386 in 1997,  1996,  and  1995,  respectively)  and the  lease  value of
personal  mileage on a company  vehicle that has been provided for Mr.  Fisher's
use ($1,800, $1,328, and $547 in 1997, 1996, and 1995,  respectively).  Pursuant
to a split-dollar  insurance  agreement between the Company and Mr. Fisher,  the
Company will be repaid such premium  payments from the proceeds of the insurance
policies.  Thus, the gross premium  payment  amounts shown  overstate the actual
economic benefit to Mr. Fisher.



                                       4
<PAGE>

Severance Plan
   
         In 1996, the Company and the Bank adopted a change in control severance
plan which became effective July 1, 1996. The plan covers  employees  designated
by the Company's Board of Directors, including Mr. Fisher.
    
         Under the plan, a "covered  termination"  is a cessation of  employment
with the  Company  or its then  affiliates  within 36  months  after a change in
control  (as  defined  in the plan) on  account  of either  (i)  termination  of
employment  by the  covered  employee  for  good  reason  (defined  to mean  the
occurrence after a change in control of any of the following:  the assignment of
duties  inconsistent with prior duties,  the diminution of  responsibilities,  a
reduction  in base salary,  a transfer of job location of more than 50 miles,  a
failure to pay  compensation  or deferred  compensation  within seven days after
due, a failure to continue  participation and benefits under any compensation or
benefits plan (or any successor or replacement plan) at as favorable a level, or
a failure of the Company to require any  successor to the Company to comply with
the plan) or (ii) termination  initiated by the Company or any of its affiliates
for any reason other than death,  disability,  mandatory retirement or cause (as
defined in the plan).

         In the event of such a covered termination,  a covered employee will be
entitled to the following severance benefits: (i) continuation of the employee's
base pay (as defined in the plan) through the earlier of his or her death or the
third  anniversary  of the date of the  change in  control  (the  severance  pay
period);  (ii) continuation of the availability of coverage,  and the employer's
regular  contribution  towards that coverage,  under the employer's  health care
plan during the  severance  pay period for the  employee and his or her eligible
dependents;  (iii) the right to buy any car that the employee is assigned by the
employer at its then fair market value; and (iv) a lump sum payment equal to the
value of any  qualified or  nonqualified  retirement  benefits  forfeited by the
employee on account of his or her covered termination.

Indebtedness and Other Transactions

         The Company's directors and officers and other  corporations,  business
organizations,  and  persons  with  whom  some of the  Company's  directors  and
officers are  associated,  had loan  transactions  at December 31, 1997 with the
Bank totaling approximately  $1,217,533, or about 5.85% of average shareholders'
equity for the year. All such  transactions  were made in the ordinary course of
business  on  substantially  the  same  terms,   including  interest  rates  and
collateral,  as those  prevailing  at the time in comparable  transactions  with
others  and did not  involve  more than the  normal  risk of  collectibility  or
present other unfavorable features.


PROPOSAL TWO               APPOINTMENT OF INDEPENDENT
                               PUBLIC ACCOUNTANTS

         S. B.  Hoover & Company,  L.L.P.  of  Harrisonburg,  Virginia,  was the
auditor  for the  Company  for 1997 and is being  recommended  to the  Company's
shareholders  for  appointment  as auditor for 1998. A  representative  of S. B.
Hoover & Company,  L.L.P. is expected to be present at the Annual Meeting,  will
have the opportunity to make a statement if he desires to do so, and is expected
to be available to respond to appropriate questions from shareholders.

                  The Board recommends a vote for Proposal Two.


PROPOSAL THREE             INCREASE IN AUTHORIZED STOCK

         On August 21,  1997,  the Board voted  unanimously  to recommend to its
shareholders an amendment of the Company's Articles of Incorporation to increase
the number of the authorized  shares of Common Stock from 2,000,000 to 3,000,000
shares. Adoption of this amendment requires the approval of more than two-thirds
of all votes entitled to be cast at the Annual Meeting.
   
    

        The text of the proposed amendment is as follows:

                                       5
<PAGE>

         The  Articles  of  Incorporation  of F & M Bank  Corp.  are  amended by
         replacing paragraph 3 with the following:

         "3. The Corporation  shall have the authority to issue 3,000,000 shares
         of the par value of $5.00 each."
   
         The Board  considers the proposed  increase in the number of authorized
shares  desirable  because it would give the Board the necessary  flexibility to
issue Common  Stock in  connection  with stock  dividends  and splits,  possible
future  acquisitions,  and the Company's  Stock Bonus Plan and for other general
corporate  purposes  without  the  expense  and delay  incidental  to  obtaining
shareholder approval of an amendment to the Articles of Incorporation increasing
the number of  authorized  shares at the time of such  action,  except as may be
required  for a  particular  issuance by  applicable  law or by the rules of any
stock  exchange  on which  the  Company's  securities  may then be  listed.  The
shareholders  of the Company do not have any  preemptive  rights with respect to
the issuance of any additional  shares of Common Stock, and the shares of Common
Stock authorized  pursuant to this proposal would likewise contain no preemptive
rights. The Company has no current plans, understandings or agreements regarding
stock  dividends and splits,  acquisitions,  and the Company's  Stock Bonus Plan
that would  cause the  Company to issue any of the  additional  shares of Common
Stock authorized by this proposal.
    
   
         The authorization of additional shares of Common Stock pursuant to this
proposal  will have no dilutive  effect upon the  proportionate  voting power of
existing  shareholders  of the Company.  However,  to the extent that shares are
subsequently  issued to  persons  other  than  existing  shareholders  and/or in
proportions other than the proportion that currently exists, such issuance could
have a substantial dilutive effect on existing shareholders.
    
   
         The  Board  believes,  however,  that  the  proposed  amendment  to the
Articles of Incorporation will provide several long-term benefits to the Company
and its  shareholders,  including  the  flexibility  to pursue  acquisitions  in
exchange  for Common  Stock of the  Company.  While the  Company has no specific
plans,  proposals,  understandings or agreements for any such  acquisition,  the
issuance of  additional  shares of Common  Stock for an  acquisition  may have a
dilutive  effect on  earnings  per share and book value per share,  as well as a
dilutive effect on the voting power of existing shareholders.  The Company would
expect that any such dilutive effect on earnings per share and/or book value per
share would be relatively short-term in duration.
    
   
         The issuance of  additional  shares of Common Stock by the Company also
may  potentially  have an  anti-takeover  effect by making it more  difficult to
obtain shareholder  approval of various actions,  such as a merger. The proposed
increase in the number of  authorized  shares of Common  Stock could  enable the
Board to render more  difficult an attempt by another person or entity to obtain
control of the  Company,  though the Board has no present  intention  of issuing
additional  shares for such  purposes  and has no present  knowledge of any such
takeover efforts.
    
                 The Board recommends a vote for Proposal Three.


                              SHAREHOLDER PROPOSALS

         Proposals of  shareholders  intended to be  presented at the  Company's
1999 Annual  Meeting must be received by the  Secretary  of the Company,  at its
principal  executive offices,  P. O. Box 1111,  Timberville,  Virginia 22853 for
inclusion in its proxy statement relating to that meeting by November 18, 1998.

                                              By Order of the Board of Directors



                                              Larry A. Caplinger, Secretary

March 13, 1998



                                       6

<PAGE>

                                      PROXY

                                F & M BANK CORP.

                 Annual Meeting of Shareholders, April 11, 1998

           THIS PROXY IS SOLICITED ON BEHALF OF THE BOARD OF DIRECTORS

         The undersigned  hereby appoints  Lawrence H. Hoover,  Jr.,  Richard S.
Myers and  Ronald E.  Wampler,  any or all of whom may act,  with full  power of
substitution,  as proxies to vote, as designated below, at the Annual Meeting of
Shareholders  to be held  April  11,  1998 at 5:30 P.M.  and at any  adjournment
thereof,  the  shares of F & M Bank  Corp.  common  stock  held of record by the
undersigned as of February 27, 1998.

         The shares to which this proxy relates will be voted as  specified.  If
no  specification  is made,  such shares will be voted in favor of the proposals
set forth on this proxy.

PROPOSAL ONE
                              ELECTION OF DIRECTORS
<TABLE>
<CAPTION>
<S>                                                     <C> 
 _                                                       _ 
|_| FOR all nominees listed below                       |_| WITHHOLD AUTHORITY to vote for all
      (except as marked to the contrary below)                 nominees listed below
</TABLE>

         Thomas L. Cline, Robert L. Halterman, Wayne L. Long and Michael W. Pugh
for three-year terms to expire in 2001.

         (INSTRUCTION: To withhold authority to vote for any individual nominee,
write that nominee's name in the space below.)

================================================================================

PROPOSAL TWO
                  APPOINTMENT OF S. B. HOOVER & COMPANY, L.L.P.
                        AS INDEPENDENT PUBLIC ACCOUNTANTS
        _                             _                               _ 
       |_| FOR                       |_| AGAINST                     |_| ABSTAIN

PROPOSAL THREE
                  INCREASE IN AUTHORIZED SHARES OF COMMON STOCK
        _                             _                               _ 
       |_| FOR                       |_| AGAINST                     |_| ABSTAIN

IN THEIR DISCRETION, THE PROXIES ARE AUTHORIZED TO VOTE UPON SUCH OTHER BUSINESS
AS MAY PROPERLY COME BEFORE THE ANNUAL MEETING.

         Please  complete,  date and sign the  proxy  and  return  it as soon as
possible in the  enclosed  postage  prepaid  envelope.  The proxy must be signed
exactly as the name or names appear on the label attached to this proxy with the
exception  of  any  stock  listed  in  the  name  of the  owner  TOD to  another
individual. If signing as a trustee, executor, etc., please so indicate.

                                        Date Signed: ___________________________

                                        ________________________________________

                                        ________________________________________
                                           Signature(s)



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