KNOW ALL MEN BY THESE PRESENT that I Member Name* of the Please Select Bermuda Clover Hill Dale Midlothian Matoaca * District of Chesterfield County do herby constitute and appoint Name of Proxy* of the Please Select Bermuda Clover Hill Dale Midlothian Matoaca * District as my true and lawful attorney, to vote as my proxy at a meeting of the Chesterfield County Republican Committee on Please Select 8/25/2025 9/29/2025 10/27/2025 11/24/2025 12/29/2025 * or an adjourned meeting thereof and for me and in my name, place and stead to vote upon any question that properly may come before such meeting with all the powers I should possess if personally present herby revoking all previous proxies.I have hereunto set my hand and affixed my seal this date Date* .