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Revocation of Power of Attorney


Revocation of Power of Attorney
Revocation of Power of Attorney
© 2012 by O’Steen & Harrison, PLC
REVOCATION OF POWER OF ATTORNEY
PRINCIPAL:
NAME
PLACE OF RESIDENCE
DATE OF BIRTH
ATTORNEY-IN-FACT/AGENT:
NAME
PLACE OF RESIDENCE
DATE OF BIRTH
TYPE OF POWER OF ATTORNEY: [ ] General [ ] Special
DATE OF POWER OF ATTORNEY SUBJECT TO THIS REVOCATION:
____________________________________
IF THE SUBJECT POWER OF ATTORNEY WAS RECORDED IN ANY COUNTY RECORDER'S OFFICE,
RECORDING DATA ARE AS FOLLOWS:
COUNTY AND STATE IN WHICH RECORDED DATE
RECORDED
DOCKET
NUMBER
PAGE NUMBER
Principal hereby revokes the above-referenced Power of Attorney and withdraws and cancels all authority and
power conferred on Attorney-in-Fact (Agent) by it.
Copies of this document have been mailed to the following persons at the addresses indicated, or it has been
published as described:
Signature of Principal
Revocation of Power of Attorney
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