Fill and Sign the Revocation Power Attorney Form

REVOCATION OF POWER OF ATTORNEY STATE OF LOUISIANA PARISH OF ________ BE IT KNOWN that on the ______ day of ________ 20 ___ , before me, the undersigned, a Notary Public duly commissioned and qualified in and for the aforesaid Parish and State, and in the presence of the undersigned witnesses, personally came and appeared: _____________ , wife of _____________ , with whom she is presently living and residing, a person of the full age of majority and a resident of ________ Parish, Louisiana, whose mailing address is _____________ ; who declared that she does hereby revoke that certain mandate and Power of Attorney granted by her to _____________ by act dated the ___ day of ________ 20 ___ , before _____________ , Notary Public, which mandate and Power of Attorney is recorded at Conveyance Book ________ , Folio ________ , under Entry No. ________ of the records of ________ Parish , Louisiana, revoking and cance ling any authority granted to the said _____________ in that instrument. THUS DONE AND SIGNED on the date indicated above at _____________ , ________ Parish, Lou isiana, in the presence o f the undersigned Notary Public, qualified in said State and Parish, and the undersigned competent witnesses, who have signed with the parties after due reading of the whole. WITNESSES: ____ _________________________ ______________________________ _____________ _____________________________ ____________________________ NOTARY PUBLIC