Beruflich Dokumente
Kultur Dokumente
I, John Smith, of 123 Main Street, Oaktown, MI 12345, hereby revoke the Power of Attorney
dated 10/01/2012, under which Sally Jones was appointed to act on my behalf.
Dated ____________________, _____, at Oaktown, MI.
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John Smith
Witness Signature:___________________________________
Name: Joe Sampson
City: Park City
State: Ohio
Witness Signature:___________________________________
Name: Jenny Bay
City: Chino
State: Illinois
_________________________________
Signature of person taking acknowledgment
_________________________________
Name typed, printed, or stamped
_________________________________
Title or rank
_________________________________
Serial number (if applicable)
Sally Jones
456 Central Ave
Rockville, Nebraska 67890
Jill Hull
8343 Market Road
Bellington, WA 75644