#1150 @001 Please enter the name of the person revoking: @115 State the date of the power of attorney being revoked: @116 State the name of the attorney in the power being revoked: #end control section #1150 /* Para. 1150: revocation of POA; Permanent or temporary */ REVOCATION OF POWER OF ATTORNEY I, @001, herewith: revoke that certain power of attorney, dated @115, naming @116 as my attorney in fact. Dated: __________________________ ____________________________________________ @001 Witnesses: ____________________________________________ ___________________________________________