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North Carolina Revocation Power of Attorney Form


North Carolina Revocation Power of Attorney Form
North Carolina Revocation Power of Attorney Form
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STATE OF NORTH CAROLINA {
{REVOCATION
OF POWER OF
ATTORNEY
COUNTY OF {
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KNOW ALL MEN BY THESE PRESENTS, that I,
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of the County and State hereinabove named, do hereby, REVOKE, ANNUL, and CANCEL that certain Power Of Attorney granted
by me, as principal, to , as attorney-in-fact, which said Power Of Attorney
was conferred by me by instrument dated the day of in the year 20 , and duly recorded
in the County Register of Deeds office, of North Carolina.
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IN TESTIMONY WHEREOF, I have hereunto set my hand and seal this day of in the year
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(seal)
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STATE OF NORTH CAROLINA
COUNTY OF
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I, a Notary Public of said State and County aforesaid, do hereby certify that
Personally appeared before me this day, and (i) have personal knowledge of the identity of the principal, or (ii) I have seen satisfactory
evidence of the principal identity, by current state or federal identification with the principal photograph in the form of a
, or (iii) a credible witness has sworn to the identity of the principal each acknowledging to me
that he or she voluntarily signed the foregoing document for the purpose stated herein and in the capacity indicated.
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Witness my hand and official seal or stamp, this the day of , in the year .
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(seal or stamp)
Notary Public Official Signature
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My commission expires:
Notary Printed or Typed Name
North Carolina Revocation Power of Attorney Form