Fillable Florida Power Of Attorney Revocation Form printable pdf download

Florida Power Of Attorney Revocation Form

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FLORIDA POWER OF ATTORNEY REVOCATION FORM

Reference is made to certain power of attorney granted by

__________________________________ (Grantor) to __________________________________

(Attorney-in-Fact), and dated _________________, 20____.

This document acknowledges and constitutes notice that the Grantor hereby revokes, rescinds

and terminates said power-of-attorney and all authority, rights and power thereto effective this

date.

Signed under seal this ____ day of_______________________________, 20____.

____________________________________

[Signature of Grantor]

____________________________________

[Printed or Typed Name of Grantor]

Acknowledged:

________________________________

STATE OF ____________________

COUNTY OF ___________________

On__________________________before me,_____________________________ personally

appeared, personally known to me (or proved to me on the basis of satisfactory evidence) to be

the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me

that he/she/they executed the same in his/her/their authorized capacity(ies), and that by

his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the

person(s) acted, executed the instrument. WITNESS my hand and official seal.

Signature: ____________________________

Affiant: ____Known ____Unknown

ID Produced ____________________

Florida Power Of Attorney Revocation Form

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