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Notice To Public Of Agency Termination
NOTICE TO PUBLIC OF AGENCY TERMINATION
To [Name of person being notified]
Notice is hereby given that I, [Name of person notifying], the undersigned, of [address of person notifying], have terminated the agency relationship between myself and *Name of person being notified], of [address of person being notified], and no longer allow the agent to act on my behalf. Such termination of agency and revocation of authority [are or were] effective [date effective].
Signature Date
Signature Date