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_SETUP.1
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1150.BLD
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1997-07-22
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49 lines
#1150
@001 Please enter the name of the person revoking:
~Enter the name of the person who is revoking the power of
~attorney. This should match the name on the power of
~attorney which is being revoked.
#1151
@115 Enter date of power being revoked:
~Enter the date on which the power of attorney which you
~are now revoking was originally signed and dated
@116 Enter name of attorney listed in power being revoked:
~Enter the person to whom you gave the power of attorney
~which you are now cancelling.
#end control section
#1150
/* Para. 1150: revocation of POA; Permanent or temporary */
REVOCATION OF POWER OF ATTORNEY
I, @001, herewith:
#1151
/* Para. 1151: Permanent revocation */
revoke that certain power of attorney, dated @115, naming @116 as
my attorney in fact.
Dated: ___________________________
_____________________________________________
@001
Witnesses:
____________________________________________
____________________________________________