Revocation of Power of Attorney

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Revocation of [insert type (special, general, etc.)] Power of Attorney


TO ALL PERSONS, let it be known that I, [insert Principal], the undersigned Principal, do hereby REVOKE IN ITS ENTIRETY that certain [insert type] Power of Attorney dated [insert date of POA] in [County, State] that was granted to [Attorney in Fact], as my Attorney in Fact. This Revocation shall be conclusive for all purposes, from the date of execution as set forth below.

I, [insert Principal], for good cause, do hereby revoke, cancel and make void the [insert type] Power of Attorney therein given and contained, for all matters granted to such Attorney in Fact. Nothing herein shall affect any actions taken by my Attorney in Fact prior to notice of this Revocation of [insert type] Power of Attorney.

Notice of this Revocation shall be binding on every person or entity to which a copy of this Revocation has been given. A copy of this Revocation shall be effective as an original for all purposes. This Revocation may be served via personal delivery, mail, facsimile transmission or other electronic transmission, and shall be effective regardless in the manner in which same is received. The undersigned absolves from liability any person who acts in accordance with this Revocation.

This Revocation of [insert type] Power of Attorney is executed on this ____ day of ______, ______, in [insert County, State].



Principal Signature


State of __________________


County of __________________


On the ______ day of _____________, 20__, before me, the undersigned, a notary public in and for said County and State, personally appeared [insert Principal], known by me personally or proven, under oath or signature, to be the person who is subscribed, by name, to the instrument in question, and that he or she executed the instrument within his or her authorized capacity either on their behalf or upon the behalf of the person who authorized the transaction.


WITNESS my hand and official seal:



Signature of Notary


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This form has been prepared for general informational purposes only. It does not constitute legal advice, advertising, a solicitation, or tax advice. Transmission of this form and the information contained herein is not intended to create, and receipt thereof does not constitute formation of, an attorney-client relationship. You should not rely upon this document or information for any purpose without seeking legal advice from an appropriately licensed attorney, including without limitation to review and provide advice on the terms of this form, the appropriate approvals required in connection with the transactions contemplated by this form, and any securities law and other legal issues contemplated by this form or the transactions contemplated by this form.

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