Tennessee Revocation of Power of Attorney


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                             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 Tennessee 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 Tennessee, (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 [STATUTE], 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 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 of 19 years of age or older].

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