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I, _________(1)____________, of __________(2)__________, by written instrument dated ________(3)____________, 19__(4)_, appointed _____________(5)______________ of ____________(6)____, my attorney in fact for the purposes and with powers therein set forth, a copy of which is attached hereto as Exhibit "A".

Notice is hereby given that I have revoked, and do hereby revoke, the above-described power of attorney, and all power and authority thereby given, or intended to be given, to

____________(5)_______________.

Dated ____________(7)_____________, 19__(8)_.

_____________(9)_______________

STATE OF _______(10)____________

COUNTY OF ______(11)____________

BEFORE ME, the undersigned authority, on this _(12)_ day of _______(13)________, 19_(14)_, personally appeared ___________(15)___________ to me well known to be the person described in and who signed the Foregoing, and acknowledged to me that he executed the same freely and voluntarily for the uses and purposes therein expressed.

WITNESS my hand and official seal the date aforesaid.

___________(16)________________

NOTARY PUBLIC

My Commission Expires:__(17)___

The information in this document is designed to provide an outline that you can follow when formulating business or personal plans. Due to the variances of many local, city, county and state laws, we recommend that you seek professional legal counseling before entering into any contract or agreement.