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Revocation of Power of Attorney

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Revocation of Power of Attorney Page 2
Revocation of Power of Attorney
© 2012 by O’Steen & Harrison, PLC
I, ____________________________________ , the Principal, sign my name to this Revocation of
Power of Attorney this _________ day of ______________________, ___________, and, being first duly sworn, do
declare to the undersigned authority that I sign and execute this instrument or direct another to sign for me, and
that I sign it willingly, or willingly direct another to sign for me, that I execute it as my free and voluntary act for the
purposes expressed in the Revocation of Power of Attorney and that I am eighteen years of age or older, of
sound mind and under no constraint or undue influence.
Signature of Principal
I,
_________________________________ , the Witness, sign my name to the foregoing Revocation
of Power of Attorney this _________ day of ______________________, ___________, and, being first duly
sworn, do declare to the undersigned authority that the Principal signs and executes this instrument as his/her
Revocation of
Power of Attorney and that he/she signs it willingly, or willingly directs another to sign for him/her,
and that I, in the presence and hearing of the Principal, sign this Revocation of
Power of Attorney as witness to
the Principal's signing and that to the best of my knowledge the Principal is eighteen years of age or older, of
sound mind and under no constraint or undue influence.
Signature of Witness
STATE OF
County of
)
)
ss.
)
Subscribed, sworn to an
d acknowledged before me by _______________________________________ _____ ,
the Principal and
________________________________ ,
the Principal (if more than one), and subscribed,
sworn to and acknowledged before
me by
_______________________________________________________________,
the
Witness, this _______ day of ________________________, ___________.
______________________________________
(Notary Seal)
___________________________________________________
________
Signature of Notary Public
Revocation of Power of Attorney
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