Docstoc Legal Agreements
This Revocation of Power of Attorney is used to revoke a power of attorney previously
executed by a individual. A power of attorney appoints an agent to act on behalf of an
principal for some specified purpose. 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 Minnesota to revoke a power of attorney.
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REVOCATION OF POWER OF ATTORNEY
I, ______________________ [Instruction: Insert the name of the principal ], of
_________________________ [Instruction: Insert the address of principal ], City of
____________________ [Instruction: Insert the City], County of _______________________
[Instruction: Insert the County], State of Minnesota , (hereinafter referred to as “Principal”) ,
having executed a _______________ [Instruction: Choose the appropriate - General or
Durable] Power of Attorney 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 my true and lawful attorney in order to handle
____________________________ [Instruction: Insert the purpose for which attorney in fact
is appointed, Example: my financial affairs and health care decisions.] I hereby revoke that
Power of Attorney in accordance with Chapter 523, Section 11 of 2010 Minnesota Statues, 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 18 years of age or older and hereby confirm Principals 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
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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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