WHEREAS, on [list date trust was made], I, [list name of person revoking the trust], executed a living trust, and,

WHEREAS, in said trust I reserved a right of revocation, I now hereby revoke the same.

Dated: _______________________________

___________________________________________________
[list name of person revoking the trust]

STATE OF [list date where trust was executed]
COUNTY OF [list county executed]
[list name of person revoking the trust], being duly sworn states that they executed this instrument for the purposes stated herein.

___________________________________________________
Notary Public

My Commission Expires: ___________________