Washington Revocation of Durable Power of Attorney for

					___ Finances 
					___ Health Care

I, ______________________________ , hereby revoke the Durable Power of Attorney I gave to

 ______________________________ .

Signature ______________________________________ Date _______________

Notarization (optional)

State of Washington
County of _______________	

I certify that I know or have satisfactory evidence that 	, is the person who appeared before me, signed above, and acknowledged that the signing was done freely and voluntarily for the purposes mentioned in this instrument.

SUBSCRIBED and SWORN to before me on 	.

							______________________________
SIGNATURE OF NOTARY

							______________________________
PRINT NAME OF NOTARY

NOTARY PUBLIC for the State of
Washington. My commission expires ___

Power of Attorney Revocation
©Seattle University School of Law Clinical Program & Northwest Justice Project