Notice of Power of Attorney Revocation Form
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Effective Date ____/____/______
I, do hereby [Legal Name], AKA [Name]
A resident of [City][State]
Located at [Address]
[City], [State] [Zip Code]
Do Hereby Appoint [Legal Name]
A resident of [City][State]
Located at [Address]
[City], [State] [Zip Code]
As my attorney-in-fact for the purposes and powers as set forth in the attached Exhibit "Power of Attorney".
Notice is hereby given that I have revoked the above mentioned attached Power of Attorney, and all the power and authority thereby granted or intended to be granted to my appointed attorney-in fact as stated above.
Applicable Law
This contract shall be governed by the laws of the State of ____ in ______ County and any applicable Federal Law.
_______________________ Date_____
Signature of Principle
WITNESS #1)
________________________________
WITNESS #2)
________________________________
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