I, _______________ (“Declarant”), of _____________________________ (Address), through my Power of Attorney dated __________________ (“Power of Attorney”) made and appointed ________________, my true and lawful attorney in fact for the purposes, and with the powers set forth in the document.

I hereby give notice that I have revoked and canceled, and hereby do revoke and cancel, the Power of Attorney, and all powers and authority given, provided or implied therein to in that Power of Attorney.

In witness of this act, I have signed this Notice of Revocation of Power of Attorney on _________ (Date).

_______________________
Revoker of Power of Attorney

On this _____________ (Date), before me, personally appeared known to be the person described in and who executed the foregoing instrument and acknowledged to me that they executed the same as their free act and deed.

__________________
Notary Public
Commission Expires on:

Power of Attorney, Revocation
Review List

This review list is provided to inform you about this document in question and assist you in its preparation. If in doubt, always revoke a Power of Attorney granted to another person. You can always reinstate a new Power of Attorney with that person or another as circumstances dictate.

1. Sign this Revocation of Power of Attorney in front of a notary to insure its holding up in Court should it be challenged at a later date. This is not absolutely required but it is strongly recommended. Courts tend to be partial to notarized documents.

2. Practically, your best bet after this Revocation is to recover and destroy all copies of the prior Power of Attorney then outstanding.

3. Send notice of the Revocation to anyone who had a copy of the original Power of Attorney, or any related party whom that person might have dealt with such as a bank, trust, or other fiduciary. Keep copies of this mailing list.

4. Keep a copy of the document in your home safe and another in accessible home files. If you have an attorney, be sure they have a copy as well.

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