Military Power of Attorney Revocation Form

I, Rank/Grade: Unit/Command: Executed Power of Attorney on (date): Name of Agent/Attorney-in-Fact: Subject or Description of Power of Attorney:

Revocation

I hereby revoke all authority and power granted under the above-referenced Power of Attorney. I request all persons and institutions to honor this revocation and to consider the above-referenced Power of Attorney as null and void as of the date signed below.

Date:

Signature:

Notary/Witness (if required):