Revocation of Power of
Attorney Care and Custody
Of Child or Children
ocstoc Legal Agreements
This document is intended to be used to revoke the Power of Attorney
granted to an Attorney for the care and custody of child or children. Please
choose your proper State document as they are intended to be in compliance
with the relevant laws.
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Attorney Drafted
REVOCATION OF POWER OF ATTORNEY
CARE AND CUSTODY OF CHILD OR CHILDREN
I, ______________________ [Instruction: Insert the name of the principal], of
_______________ [Instruction: Insert the address of the principal ], City of
_________________ [Instruction: Insert the City], County of _______________________
[Instruction: Insert the County], State of Montana executed a Power of Attorney: Care and
Custody of Child (ren) for the child (ern) listed below:
NAME AGE SEX
1. ____________________________ ____________ M/F
2. ____________________________ ____________ M/F
3. ____________________________ ____________ M/F
On the ______ [Month] __ [Date], 20____, to __________________________ [Instruction:
Insert the name of attorney-in-fact/agent] my attorney-in-fact/agent, to act in my behalf as a
Child Caregiver, hereby revoke that Power of Attorney in accordance with Title 72, Chapter 5,
Section 502 of 2009 Montana Code by written revocation signed and dated by me. And pursuant
to its explicit provision that it may be revoked by me by written instrument signed by me and
delivered to my attorney-in-fact/agent.
This is my written revocation of the above referenced Power of Attorney and I am providing a
copy of it to my attorney-in-fact/agent.
Signature of Principal : ______________________________________________
Printed Name of Principal : ______________________________________________
I, at the request and in the presence of _________________ [Instruction: Insert the name of
the Principal] have subscribed my name below as witness. I declare that I am of sound mind
and of 19 years of age or older and hereby confirm Principals expression to revoke the
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_______________ [Instruction: Choose the appropriate - General or Durable] Power of
Attorney. To the best of my knowledge the Principal is of the age of majority, or is otherwise
legally competent to revoke a Power of Attorney, and appears of sound mind and under no undue
influence or constraint. Under penalty of perjury, I declare these statements are true and correct
on this ________ day of ____________________, 20______.
Witness Signature #1 : _____________________________________________
Name : _____________________________________________
Address : _____________________________________________
[Instruction: The witness must be of 19 years of age or older].
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