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Fill and Sign the Revocation of General Durable Power of Attorney Oregon Form

Fill and Sign the Revocation of General Durable Power of Attorney Oregon Form

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REVOCATION OF GENERAL POWER OF ATTORNEY I, ___________________________________________________________________, Declarant, having executed a General Durable Power of Attorney on the ________ day of ________________________, 20____, naming _______________________________________ ___________________________________ my attorney-in-fact/agent, do hereby revoke that Power of Attorney pursuant to its explicit provision that it may be revoked by me by written instrument signed by me and delivered to my attorney-in-fact/Agent. This is my written revocation of the above referenced General Durable Power of Attorney and I am providing a copy of it to my attorney-in-fact/Agent. Signed this _________ day of __________________________________________, 20________ ___________ ___________________________________ Signature ___________ ___________________________________ City, County, and State of Residence The principal(s) is(are) personally known to me and I believe the principal(s) to be of sound mind. I am eighteen (18) years of age or older. I am not related to the principal(s) by blood or marriage, or related to the attorney-in-fact by blood or marriage. The principal(s) has(have) declared to me that this instrument is his(their) power of attorney granting to the named attorney- in-fact the power and authority specified herein, and that he(they) has(have) willingly made and executed it as his free and voluntary act for the purposes herein expressed. Witness: ___________ _____________________________ Witness: ___________ _____________________________ STATE OF OREGON County of _________________________ Personally appeared before me ____________________________________________________ who acknowledged the execution of the above Power of Attorney to be his/her free act and deed on this the _________ day of ___________________________________________, 20_______. __________________________________ Notary Public

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