State of
I, , the undersigned, residing at (hereinafter referred to as the "Principal"), an authorized representative of the , company registered at (the "Company"), hereby revoke, cancel, and terminate the Power of Attorney executed on , appointing residing at as attorney-in-fact. no longer have the authority to act on Company's behalf as of .
IN WITNESS WHEREOF, I have hereunto set my hand.
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Signature of the Principal
IN THE PRESENCE OF
Witness 1
Signature: _________________
Legal name:
NOTARY ACKNOWLEDGMENT
On , before me, , a notary public, personally appeared , known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that the Principal executed the same freely and voluntarily for the purposes therein contained and being of lawful age, competent, and fully capable of understanding the nature and consequences of the signed document.
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Notary public's signature
WITNESS my hand and official seal.
Notary public:
My commission expires on
Notary public's commission number:
Notary public's seal
The copy is delivered to: