Pennsylvania General Power Of Attorney Form (Page 6 of 8) in pdf

Pennsylvania General Power Of Attorney Form Page 6

I may revoke this Power of Attorney at any time by providing written notice to my

Agent.

Signed on ________________ (date), at _______________________ (city),

Pennsylvania.

________________________________

Signature of Principal

Witness Signature: ___________________________________

Name: ___________________________________

City: __________________________________

State: ___________________________________

Witness Signature: ___________________________________

Name: ___________________________________

City: __________________________________

State: ___________________________________

State of PENNSYLVANIA

)

) ss

County of ________________________ )

The foregoing instrument was acknowledged before me this _____ day of

____________________, ______ by __________________________ (name of

Principal), who is personally known to me or who has produced

________________________________ as identification.

_________________________________

Signature of person taking acknowledgment

(Notary Public)

_________________________________

Name typed, printed, or stamped

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Pennsylvania General Power Of Attorney Form Page 6