Revocation of Power of Attorney

I, * (printed name) , address: * 
do revoke the power of attorney dated * , 20 *  ,
which was granted to * (printed name), address:* ,

to act as my attorney-in-fact.

This Revocation is dated *  , 20 * 

*
Signature of Person Revoking Power of Attorney


Notary Acknowledgement

State of ____________________
County of ____________________

On _____________________ , 20 _____ , _______________________________ personally came
before me and, being duly sworn, did state that he or she is the person described in the above
document and that he or she signed the above document in my presence.

______________________________
Signature of Notary Public

Notary Public, In and for the County of ____________________
State of ____________________

My commission expires: __________________    Notary Seal