REVOCATION OF POWER OF ATTORNEY 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 or Typed Name of Grantor] (Acknowledgment by a person in New York State - Use Acknowledgment below if by a person outside New York State) State of New York, County of ________________________, ss: On ______________________________________, before me, the undersigned, personally appeared _____________________________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. (Signature and office of individual taking acknowledgement) American LegalNet, Inc. www.FormsWorkFlow.com (Acknowledgment by a subscribing witness outside New York State) *State of ________________________, County of ________________________, ss: *(Or insert District of Columbia, Territory, Possession or Foreign County) On _______________________________________, before me, the undersigned, personally appeared _____________________________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument, and that such individual made such appearance before the undersigned in ________________________________________________________________________________________. (insert the city or other political subdivision and the state or county or other place the acknowledgement was taken). (Signature and office of individual taking acknowledgement) American LegalNet, Inc. www.FormsWorkFlow.com