I, __________, of __________, by written instrument dated __________, 20____, appointed __________ of __________, 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 __________.