Affidavit of Revocation
State of _________________
County of _________________ ss.
The undersigned, _________________________ (hereinafter, “affiant”), being first duly sworn, deposes
and states that _________________________ (hereinafter, “principal”), executed a certain power of
attorney appointing affiant of his/her Attorney-In-Fact on __________, 20________, and that as of the
date hereof, Affiant has no actual knowledge of revocation of the Power of Attorney by the Principal, or
the revocation of the Power of Attorney by death or adjudged incompetency of the Principal.
Affiant also states, when I have knowledge of the revocation I will promptly notify Key Bank National
Association in writing of the revocation.
Further Affiant saith not.
In whiteness whereof, affiant has executed this affidavit this day of __________,20________.
Signed and acknowledged in the presence of:
_________________________________________
Signature
_________________________________________ _________________________________________
Witness Affiant
State of _________________
County of _________________ ss.
Before me a Notary Public in and for said County and State, personally appeared the above-mentioned
Affiant, _________________________who swore to or affirmed, subscribed and acknowledged the
foregoing affidavit and that the same is his/her free act and deed.
In testimony whereof, I have hereunto subscribed my name and affixed my official seal
at________________,__________________ ,this__________ day of ________,20________.
________________________________
Notary Public
________________________________
My Commission Expires
Mailing address is KeyDirect PO Box 1300 Buffalo NY 14240