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Fill and Sign the Revocation Power Attorney 497327839 Form

Fill and Sign the Revocation Power Attorney 497327839 Form

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REVOCATION OF POWER OF ATTORNEY I, ___________________________________________________________________, Declarant, having executed a Statutory 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 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: ___________________________________________________________ STATE OF TEXAS COUNTY OF _______________________ This document was acknowledged before me on _______________________(date) by ______________________________________________________________ (name of principal) ___________________________________ (signature of notarial officer) (Seal, if any, of notary) ___________________________________ (printed name) My commission expires: _______________

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