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Name of the Council?

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* 1. Name of the Council?

Name and details of the person formally appointed as proxy -

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* 2. Name and details of the person formally appointed as proxy -

Minute reference where proxy voter was formally appointed -

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* 3. Minute reference where proxy voter was formally appointed -

Leaving the voting decisions to the appointed proxy?

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* 4. Leaving the voting decisions to the appointed proxy?

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