Document text
Revocation of Power of Attorney
Date: [DATE]
1. Principal
I, [FULL NAME OF PRINCIPAL], residing at [STREET ADDRESS, CITY, STATE, ZIP], am the principal who signed the power of attorney described below.
2. Power of attorney being revoked
Date signed: [DATE THE POWER OF ATTORNEY WAS SIGNED]
Agent named in it: [FULL NAME OF AGENT], of [AGENT'S ADDRESS]
Successor or co-agents named in it, if any: [NAMES OR "NONE"]
Type: [GENERAL / DURABLE / LIMITED TO A SPECIFIC MATTER]
Recorded with a county office, if it was: [COUNTY, BOOK AND PAGE OR INSTRUMENT NUMBER, OR "NOT RECORDED"]
3. Revocation
I revoke the power of attorney described in section 2 in full. I also revoke the authority of every agent, co-agent and successor agent named in it.
This revocation takes effect on [EFFECTIVE DATE, OR "THE DATE I SIGN IT"].
From that date, [FULL NAME OF AGENT] has no authority to act for me under that power of attorney. Please:
Stop all actions in my name under it.
Return the original power of attorney and every copy you have to me at the address above by [DATE].
Give me a written list of the transactions you made for me under it, with copies of receipts and statements.
This revocation [DOES / DOES NOT] apply to any other power of attorney or health care directive I have signed. [IF IT DOES, DESCRIBE THEM BY DATE AND TYPE]
4. Signature of principal
____________________
[FULL NAME OF PRINCIPAL], principal
Date: [DATE]
5. Notary acknowledgment (recommended)
Use the acknowledgment certificate of the state where you sign. The notary completes this part.
State of [STATE], County of [COUNTY]
On [DATE], before me, [NAME OF NOTARY], personally appeared [FULL NAME OF PRINCIPAL], who proved to me on the basis of satisfactory evidence to be the person who signed this document, and acknowledged signing it.
____________________
Notary public, commission expires [DATE]
6. Received by agent
I received a copy of this revocation on [DATE] by [HAND DELIVERY / FIRST-CLASS MAIL / EMAIL].
____________________
[FULL NAME OF AGENT], agent
Notice of Revocation to a Third Party
To: [NAME OF BANK, BROKER, TITLE COMPANY OR OTHER PERSON THAT RELIES ON THE POWER OF ATTORNEY]
Attention: [OFFICER OR MANAGER, BRANCH ADDRESS]
Principal: [FULL NAME OF PRINCIPAL], [STREET ADDRESS, CITY, STATE, ZIP]
Last four digits of the principal's taxpayer identification number: [LAST 4 DIGITS]
Accounts or matters concerned: [ACCOUNT NUMBERS OR DESCRIPTION]
I revoked the power of attorney dated [DATE THE POWER OF ATTORNEY WAS SIGNED] naming [FULL NAME OF AGENT] as my agent. The revocation took effect on [EFFECTIVE DATE]. A copy of the signed revocation is attached.
Please do not accept instructions from [FULL NAME OF AGENT] under that power of attorney and update your records. Confirm receipt to me at [PHONE OR EMAIL].
____________________
[FULL NAME OF PRINCIPAL]
Date: [DATE]
For me: before and after I sign
[ ] I described the old power of attorney by date and agent's name, so nobody can confuse it with another one
[ ] I signed the revocation in writing (Florida asks for a writing signed by the principal: Fla. Stat. 709.2110)
[ ] I gave a copy to the agent and kept proof of delivery (mail receipt, email, or the agent's signature in section 6)
[ ] I sent the notice to every bank, broker or office that has a copy of the old power of attorney: a person who acts in good faith without actual knowledge of the revocation may still rely on it (Va. Code 64.2-1608(D); RCW 11.125.100(5))
[ ] Florida: the notice is written, names an officer or manager, and has my name, address and last four digits of my taxpayer ID; for a bank it works 5 business days after receipt (Fla. Stat. 709.2121)
[ ] If the old power of attorney was recorded with the county, I asked the county recorder how to record the revocation
[ ] If I sign a new power of attorney, it says that earlier ones are revoked (Va. Code 64.2-1608(F); Fla. Stat. 709.2110(2))