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Important
Note:
Forms are to be used as a guide only to assist you. No liability is assumed for errors in substance or form. It is your responsibility to revise the forms to meet current law
requirements and your particular situation. No liability is assumed for improper use of these forms.
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NOTICE
OF REVOCATION OF POWER OF ATTORNEY
I,
_______________________, of ______________________, by written instrument
dated
______________________, 19_____, appointed _____________________________ of
__________________,
my attorney in fact for the purposes and with powers therein set forth, a
copy of which is
attached hereto as Exhibit "A".
Notice is hereby
given that I have revoked, and do hereby revoke, the above-described
power of
attorney, and all power and authority thereby given, or intended to be given, to
_____________________________.
Dated
___________________________, 19_____.
______________________________
STATE OF
_____________________
COUNTY OF
____________________
BEFORE ME, the
undersigned authority, on this ____ day of _________________, 19____,
personally
appeared ________________________ to me well known to be the person described in
and who signed
the Foregoing, and acknowledged to me that he executed the same freely and
voluntarily for
the uses and purposes therein expressed.
WITNESS my hand
and official seal the date aforesaid.
_____________________________
NOTARY PUBLIC
My Commission
Expires:_______
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