Revocation of Authorization to Communicate Information or of Power of Attorney
MR-69.R-V

Complete this form to revoke an authorization or power of attorney granted to a designated person.

This form cannot be used to grant an authorization or power of attorney.

To grant an authorization or power of attorney, complete form MR-69-V, Authorization to Communicate Information or Power of Attorney.

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Note about electronic signatures.

This form can be signed electronically.

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2018-11 version

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