REVOCATION OF POWER OF ATTORNEY Whereas the undersigned, of by a writing dated ___________,20__ did make, constitute and appoint _____________ of _______________________ as my attorney in fact. Now, therefore, the undersigned hereby revokes and makes void the said power of attorney forthwith and all powers authority conferred thereby is terminated and shall cease as the date subscribed below. Dated: ______________________________ __________________________ Witness Form 613