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Fill and Sign the Revocation of Power of Attorney for Care of Child or Children Illinois Form

Fill and Sign the Revocation of Power of Attorney for Care of Child or Children Illinois 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____. Signature of Declarant: __________________________________________________________ Printed Name of Declarant: _______________________________________________________ Address of Declarant: ___________________________________________________________

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