Power of Attorney Revocation
Reference is made to certain power of attorney granted by ___________________________ (Grantor) to ______________________________(Attorney-in-Fact), and dated the _____ day of __________,20__ .
This document constitutes notice that the Grantor hereby revokes, rescinds and terminates said power-of-attorney and all authority, rights and power thereto effective this the _____ day of ____________, 20__.
STATE OF )
COUNTY OF )
Subscribed and sworn before me this the _____ day of ____________, 20__.
WITNESS my hand and official seal.
______________________________ My commission expires: