Revocation Of Power Of Attorney
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1
2REVOCATION OF POWER OF ATTORNEY
1. IDENTIFY Principal and Attorney-in-Fact:
Principal: Name
Address of Residence
City
State Zip Code
D/O/B (
MM/DD/YR)
Agent /Attorney-In-Fact: Name
Address of Residence
City
State Zip Code
D/O/B (
MM/DD/YR)
2. REVOCATION by Principal:
I,
of
, city of
,
(Principal's printed name)
(Principal's Street Address)
in the County of
,
State of
,
(Zip Code)
hereby revoke the Power of Attorney dated
, 20
given to, and empowering
to act in my behalf as my true and lawful
(Name of Attorney-in-Fact)
Attorney in Fact to handle my affairs. I declare that all power and authority granted under said of Power of Attorney is
hereby revoked and withdrawn, and Attorney in Fact no longer has the authority to act in my behalf in any matter.
, 20____
Principal Signature
Date
3. SIGNATURE of WITNESS:
(Printed Name of Witness)
(Signature of Witness)
(Address of Witness)
(City, state & zip code of Witness)
THIS PART OF THE DOCUMENT LEFT
INTENTIONALLY BLANK.
NOTARY SIGNATURE ON NEXT PAGE
Page 1 of 2
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Parent category: Legal