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__.

 

 

_______________________________

Grantor

 

Acknowledged:

STATE OF )

COUNTY OF )

Subscribed and sworn before me this the _____ day of ____________, 20__.

WITNESS my hand and official seal.

______________________________ My commission expires:

Notary Public