insurance agent or agents for issuance of certificates of release. A title insurance company shall use the following form for the purpose of revoking the appointment of its title insurance agent's authorization for executing certificates of release pursuant to this Act. REVOCATION OF APPOINTMENT OF TITLE INSURANCE AGENT OR AGENTS FOR ISSUANCE OF CERTIFICATES OF RELEASE .... (name of title insurance company) revokes the appointment of ..... (name of title insurance agent or agents) to act as its agent for the purpose of executing and delivering for recording certificates of release as provided by the Mortgage Certificate of Release Act. This Revocation shall be effective upon the recording in each county, or on ..... (date), if subsequent to recording. A copy of this Revocation has been delivered to the named title insurance agent or agents by certified U. S. mail, return receipt requested, at the following address or addresses: .....(name of title insurance agent) .....(address) Dated this ..... (date). By: ..... (title insurance company) ..... (signature) ..... (typed / printed name & title) ..... (address) ..... (telephone number) State of Illinois) ) County of ) This instrument was acknowledged before me on .....(date) by .....(name of person) as .....(officer for / agent of) .....(title insurance company). ..... Notary Public My commission expires on.....
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