I/We, ___________________________________________________ (Parent(s)/Principal(s)) maintaining an address at: ________________________________________ hereby give notice that I/We revoke effective immediately the Power of Attorney for the Care of Children, and all powers and authority given, provided or implied therein to _____________________________ (Agent/Attorney in Fact) on _________________ (date of power of attorney).
A copy of this revocation is being provided to the Agent/Attorney-in-Fact
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