Revocation of Durable Power of Attorney

I, residing at hereby revoke the Durable Power of Attorney previously granted to: Name of Agent/Attorney-in-Fact Agent's Address

Originally executed on (Date) Additional Details (if any)

This revocation is effective immediately upon execution and delivery to the above-named Agent/Attorney-in-Fact and any relevant third parties.

Witness

Name of Witness Signature of Witness Date