1. Description of Power of Attorney. KNOW ALL MEN BY THESE PRESENTS, that I, [name], residing at [address], did by an instrument dated [date] constitute and appoint [name], residing at [address], my true and lawful Attorney-in-Fact for me to do any and all acts that I could do if personally present.
2. Revocation of Power of Attorney. BY THESE PRESENTS I revoke and make void the instrument described above and all power to act for me given be that instrument to [name].