Revocation of Power of Attorney
This Revocation of Power of Attorney is executed in accordance with the laws of the State of __________.
Know all men by these presents, that I, [Your Name], residing at [Your Address], hereby revoke any and all Power of Attorney documents previously executed by me.
This Revocation is specifically applicable to the Power of Attorney granted to:
[Agent's Name] residing at [Agent's Address].
The following documents are hereby revoked:
- Power of Attorney dated [Date of Original Power of Attorney].
This Revocation is effective as of the date signed below. Any third parties, including financial institutions, health care providers, or others who received information under the original Power of Attorney, should be notified of this revocation.
I affirm that I am of sound mind and legal capacity to execute this document.
In witness whereof, I have signed my name this ___ day of __________, 20__.
[Your Signature]
[Your Printed Name]
Witnesses:
- ______________________ Sign Name: ______________________ Date: _______________
- ______________________ Sign Name: ______________________ Date: _______________
Notary Public:
State of __________ | County of __________
Subscribed and sworn before me this ___ day of __________, 20__.
[Notary’s Signature]
[Notary's Printed Name]
My commission expires: _______________