Oklahoma Revocation of Power of Attorney - Care and Custody of Children


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                             This Revocation of Power of Attorney is used to revoke a power of attorney for care and
                             custody of children previously executed by a individual. A power of attorney appoints an
                             agent to act on behalf of an principal for some specified purpose, such as to take care of
                             the principal's children. This document effectively revokes the authority granted to the
                             agent and complies with state laws that require the revocation to be in a signed written
                             instrument and delivered to the agent. This should be utilized by a principal located in
                             Oklahoma to revoke a power of attorney for the care and custody of children.

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                        REVOCATION OF POWER OF ATTORNEY


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 Oklahoma, executed a Power of Attorney: Care and
Custody of Child(ren) for the child(ren) 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 12, Chapter 49,
Section 4 of 2011 Oklahoma 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 19 years of age or older and hereby confirm the Principal’s expression to revoke the
_______________ [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 at least 19 years of age]

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