The web content you are viewing is provided to you free of charge. To ensure that this content will continue to be available please click on the ad links on this page. (Please click here to delete prior to using this form)
Revocation of Power of Attorney
I,_______________________(Principal's name), of ________________(Principal's Street Address), city of _________________________, County of __________________________, State of ____________________________, hereby revoke the power of attorney dated __________________, 20___ given to, and empowering ____________________________ __________________ (name of Attorneyin-Fact) to act in my behalf as my true and lawful attorney in order to handle my financial affairs and health care decisions should I become incapacitated and not be able to do so myself, and I declare that all power and authority granted under said of power of attorney is hereby revoked and withdrawn. Dated: ________________________, 20___. _____________________________ Principal WITNESS 1- _____________________________ of _________________________________(address) 2- _____________________________ of _________________________________(address) NOTARY IN WITNESS WHEREOF, I, a notary Public of the State of ______________, duly commissioned and sworn, have hereunto set my hand and affixed my official seal in the _________________ County of _______________________ on this date of _________________, 20____. ___________________________________ Notary My commission expires: _____/_____/__________