REVOCATION OF POWER OF ATTORNEY
I, [PRINCIPAL NAME], residing at [PRINCIPAL ADDRESS], hereby declare that I am of sound
mind and competent to make this important legal decision. I am the principal who executed a
Power of Attorney dated [ORIGINAL POA DATE], appointing [AGENT NAME] as my attorney-
in-fact.
I hereby revoke, annul, and cancel the aforementioned Power of Attorney and all powers, rights,
and authority granted to [AGENT NAME] under that document. This revocation is effective
immediately as of [REVOCATION DATE].
Please be advised that [AGENT NAME] no longer has my authority to act on my behalf in any
capacity as previously granted in the now-revoked Power of Attorney. This revocation applies to
all acts, whether financial, legal, or otherwise.
ACTIONS TAKEN:
I have informed [AGENT NAME] of this revocation in writing.
I have destroyed all original and copies of the previous Power of Attorney document to
prevent any further or future use.
I am notifying all third parties and entities who have previously relied on the authority of the
revoked Power of Attorney to cease acceptance of any actions by [AGENT NAME] on my
behalf.
ACKNOWLEDGMENT OF REVOCATION
This revocation document has been prepared and executed in accordance with the laws of
[GOVERNING LAW], and I intend this revocation to be distributed to all necessary parties to
inform them of the change in legal authority concerning my affairs.
_____________________________ _____________________________
Signature of Witness Signature of Witness
_____________________________ _____________________________
Street Address Street Address
_____________________________ _____________________________
City, State and Zip Code City, State and Zip Code
IN WITNESS WHEREOF, I have hereunto set my hand on this the _____ day of
_________________, 20____.
_____________________________
Signature of Principal
NOTARY ACKNOWLEDGMENT (if required)
State of __________________
County of __________________
On _________________, 20____, before me, __________________, a Notary Public in and for
said State, personally appeared __________________, known to me (or satisfactorily proven) to
be the person whose name is subscribed to the within instrument and acknowledged that he/she
executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
(Notary Seal) _____________________________
Notary's Signature
My Commission Expires:
_____________________________
