0001481730-11-000005.txt : 20110902
0001481730-11-000005.hdr.sgml : 20110902
20110902150635
ACCESSION NUMBER: 0001481730-11-000005
CONFORMED SUBMISSION TYPE: PREN14A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20110902
FILED AS OF DATE: 20110902
DATE AS OF CHANGE: 20110902
SUBJECT COMPANY:
COMPANY DATA:
COMPANY CONFORMED NAME: KAVILCO INC/WA/
CENTRAL INDEX KEY: 0000859765
IRS NUMBER: 920045958
STATE OF INCORPORATION: AK
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: PREN14A
SEC ACT: 1934 Act
SEC FILE NUMBER: 811-06027
FILM NUMBER: 111073434
BUSINESS ADDRESS:
STREET 1: ONE UNION SQUARE
STREET 2: SUITE 3010
CITY: SEATTLE
STATE: WA
ZIP: 98101
BUSINESS PHONE: 2066246166
FILED BY:
COMPANY DATA:
COMPANY CONFORMED NAME: Olsen Frederick Otilius Jr
CENTRAL INDEX KEY: 0001481730
FILING VALUES:
FORM TYPE: PREN14A
MAIL ADDRESS:
STREET 1: P.O. BOX 371
CITY: KASAAN
STATE: AK
ZIP: 99950-0340
PREN14A
1
ProxCard2011y.txt
PRELIMINARY PROXY CARD
FREDERICK OTILIUS OLSEN JR. PROXY
Solicitation by FREDERICK OTILIUS OLSEN, JR. for the 2011 KAVILCO, INCORPORATED
Annual Meeting of Shareholders
You have the option of voting your Proxy by mail or in person--it is easy and
confidential.
Vote by (1) marking your nominee selection(s) by assigning a number of shares
to the designated nominee on the appropriate line(s); or (2) check the
appropriate box.
Vote by Mail: Return Proxy in Return Envelope provided.
Mail to: Mecham, Richardson & Co
1734 Tongass Avenue
Ketchikan, Alaska 99901
Mailed Proxies must be received no later than Friday November 4, 2011 at 5 PM.
Please allow for sufficient time for delivery.
Vote in Person:
Return Proxy in Person to the KAVILCO INCORPORATED Annual Meeting at the Cape
Fox Lodge, 800 Venetia Way, in Ketchikan, Alaska, on November 5, 2011 at 1:00
PM. If you vote by more than one method, only the last vote received will
count. The undersigned hereby appoints FREDERICK OTILIUS OLSEN, JR. {P.O. Box
371, Kasaan, Alaska 99950-0340} with full power of substitution, as proxy for
the undersigned, to attend the Annual Meeting of Shareholders of KAVILCO
INCORPORATED, a village corporation within the Sealaska region, organized
pursuant to the Alaska Native Claims Settlement Act (ANCSA), to be held at the
Cape Fox Lodge, 800 Venetia Way, in Ketchikan, Alaska on Saturday November 5,
2011, at 1 PM, or any adjournment thereof, and to vote the number of votes that
the undersigned would be entitled to vote, and with all the power the
undersigned would possess, if personally present, as follows:
(1) TO VOTE DIRECTED in the manner set forth below for the election of the
Nominees below for the Board of Directors of the Corporation for three-year
terms ending in 2012.
Nominee Number of Shares X 3 = Number of Votes Cast
Frederick Otilius Olsen, Jr. __________ X 3 = ___________
Jeane Breinig __________ X 3 = ___________
Ramona Hamar __________ X 3 = ___________
Marie Miller __________ X 3 = ___________
Proxy Solicitation by FREDERICK OTILIUS OLSEN, JR.
for the 2011 KAVILCO, INCORPORATED Annual Meeting of Shareholders
(2) To ratify the selection Moss Adams LLP as the independent public accountants
of the Corporation.
FOR [ ] AGAINST [ ] ABSTAIN [ ]
This Proxy, when properly signed, will be voted as directed by the person voting
the Proxy as to such other matters as may properly come before the meeting.
FREDERICK OTILIUS OLSEN, JR. knows of no other matters to be considered by the
Shareholders. Only Proxies properly returned will be voted. These will be voted
as you direct. If you sign the proxy and return it without indicating how you
wish to vote, your proxy will be cast for your total number of possible votes to
FREDERICK OTILIUS OLSEN, JR.
FREDERICK OTILIUS OLSEN, JR. solicits this Proxy and it will be voted as
specified.
Full Name: __________________________
Class of Stock: ___A___
Number of Shares: _______
Dated: ___________, 2011
SIGNATURE: __________________________
(Sign your full name as it appears above)
As Custodian For:____________________
(Minor's name if applicable)
When signing as custodian for a minor, or as executor, administrator, attorney,
trustee, or guardian, please write your full title as such. If your name appears
as "John A. Smith, Sr., as custodian for John A. Smith,Jr.", sign "John A.
Smith, Sr., as custodian for John A. Smith, Jr."
YOUR PROXY WILL NOT BE COUNTED UNLESS YOU SIGN YOUR NAME IN THE PROXY SIGNATURE
FIELD PROVIDED.