Revocation Of Power Of Attorney Page 2
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2(Acknowledgment by a subscribing witness outside New York State)
*State of ________________________, County of ________________________, ss:
*(Or insert District of Columbia, Territory, Possession or Foreign County)
On _______________________________________, before me, the undersigned, personally appeared
_____________________________________________, personally known to me or proved to me on the basis
of satisfactory evidence to be the individual(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 capacity(ies), and that by his/her/their
signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument, and that such individual made such appearance before the undersigned in
________________________________________________________________________________________.
(insert the city or other political subdivision and the state or county or other place the acknowledgement was taken).
(Signature and office of individual taking acknowledgement)
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