Power of Attorney Revocation
This form revokes assigned power of attorney. The form letter provided here is simply a sample of what the actual form letter looks like.
POWER OF ATTORNEY REVOCATION
Reference is made to certain power of attorney granted by ____________________________ (Grantor)
to ____________________________ (Attorney-in-Fact),
and date ____________________________, 21______.
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 ____________________________, 21_______.
_______________________________
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)