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Fill and Sign the Florida Revocation 497303348 Form

Fill and Sign the Florida Revocation 497303348 Form

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REVOCATION POWER OF ATTORNEY: CARE AND CUSTODY OF CHILD OR CHILDREN I, ___________________________________________________________________________, Declarant, having executed a Power of Attorney: Care and Custody of Child or Children on the ________ day of _________________________________________, 20____, naming _______________________________________ ___________________________________ my attorney-in-fact/agent, do hereby revoke that Power of Attorney pursuant to its provision that it may be revoked by me in writing. This is my written revocation of the above referenced Power of Attorney and I am providing a copy of it to my attorney-in-fact/Agent. DATED this the _________ day of ______________________________, 20____. _____________________________________ ___________________________________________ Witness Declarant Print Name: ___________________________ _____________________________________ Witness Print Name: ___________________________ Name of Declarant: _____________________________________________________________ Printed Name of Declarant: _______________________________________________________ Address of Declarant: ___________________________________________________________

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