POWER OF ATTORNEY REVOCATION
Reference is made to certain power of attorney granted by _________________________ (Grantor) to __________________________________ (Attorney-in-Fact), and dated _________________, 20____.
This document acknowledges and constitutes notice that the Grantor hereby revokes, rescinds and terminates said power-of-attorney and all authority, rights and power thereto effective this date.
Signed under seal this ____ day of_______________________________, 20____.
____________________________________
[Signature of Grantor]
____________________________________
[Printed Name of Grantor]
ACKNOWLEDGED BY:
________________________________
STATE OF VIRGINIA
COUNTY OF ___________________
On __________________________ [date] before me, ____________________________ [Grantor] personally appeared, proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal.
Signature:____________________________
ID Produced ____________________
(Seal)
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