POWER OF ATTORNEY REVOCATION 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 ____________________
(Seal)