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
2 digit month, 2 digit day, 4 digit yearDate
Proxy Effective Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Proxy Expiration Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: