Revocation Of Power Of Attorney
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1STATE OF OHIO
:
: ss
_________ COUNTY :
REVOCATION OF POWER OF ATTORNEY
I, ___________________________________________________, whose permanent address is
____________________________________________________________________________________,
hereby revoke and render void the power of attorney I previously gave to _____________________ of
______________________________(city of residence), signed in ________.(year)
I further attest that a photostatic copy of this Revocation of Power of Attorney constitutes a
"duplicate original" of said Revocation of Power of Attorney and thus is as effective as the original
revocation itself.
Signed by me as an act of my free will under no legal or other duress this ____ day of
_____________, 20_____.
_____________________________________
This revocation of Power of Attorney was sworn to and subscribed before me by
_______________________________________________on __________________, 20____.
Notary Public
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