POWER OF ATTORNEY REVOCATION

Reference is made to certain power of attorney granted by __________________________________ (Grantor) to __________________________________ (Attorney-in-Fact), and dated _________________, 20____.

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_______________________________, 20____.



____________________________________
[Signature of Grantor]

____________________________________
[Printed or Typed Name of 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)