REVOCATION NOTICE

(Name of Corporation)

(Date)

Effective (Power of Attorney) (Concurrence) Tp. ______ No. ______ issued by (name of public utility) in favor of (here show name of public utility in whose favor issued) is hereby cancelled and revoked.

(Name of Corporation)

By (Signature of Officer)

(Title of Officer)

(If a corporation)

Attest:

(Corporate Seal), Secretary.

Duplicate mailed ( Date ) to _____ at