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Revocation of Power of Attorney
REVOCATION OF POWER OF ATTORNEY
Whereas the undersigned, of by a writing dated
___________,19__ did make, constitute and appoint _____________
of _______________________ as my attorney in fact.
Now, therefore, the undersigned hereby revokes and makes
void the said power of attorney forthwith and all powers
authority conferred thereby is terminated and shall cease as the
date subscribed below.
Dated:
______________________________ __________________________
Witness
Form 613
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