I, __________________________________________________ (Principal), of ___________________________________________________________ (Principal ‘s Address), hereby give notice that I revoke effective immediately the Power of Attorney, and all powers and authority given, provided or implied therein to ________________________________________ (Agent) on _________________ (date of power of attorney).
I am providing a copy of this revocation to my Agent/Attorney-in-Fact.
FOR A COMPLETE VERSION OF THIS FORM, CLICK ON THE BLUE BUTTON BELOW