HOA Proxy Authorization Form

HOA Proxy Authorization Form
Use this form to authorize another person to vote on your behalf for a specific HOA meeting or limited set of agenda items.
Member and Property Information
Homeowner Full Name
First NameMiddle NameLast Name
Property / Unit Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
HOA Association Name
Meeting and Proxy Details
HOA Meeting Name or Type
Meeting Date
MonthDayYear
Date
Proxy Effective Date
MonthDayYear
Date
Proxy Expiration Date
MonthDayYear
Date
Scope of Proxy Authority
Specific Agenda Items or Vote Instructions
Proxy Holder Information
Proxy Holder Full Name
First NameMiddle NameLast Name
Proxy Holder Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Proxy Holder Email Address
example@example.com
Authorization and Signature
I understand this proxy is valid only for the meeting and scope stated above.
Member Signature
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Signature Date
MonthDayYear
Date
Should be Empty: