Revocation of Military Power of Attorney

This form is used to revoke a previously executed Military Power of Attorney.

Principal Information

Unit or Organization

Attorney-in-Fact Information

Address

Power of Attorney Information

Date Power of Attorney Was Executed Description of Power of Attorney

Revocation Statement

I hereby revoke the Power of Attorney described above, and all authority granted by it is terminated effective immediately.

Notary Public

Notary Name Commission Number My Commission Expires Notary Seal Notary Signature Date