What is the Principal's name? Enter the name of the person who is revoking the power of attorney. What is the Principal's mailing address? Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code When does this revocation go into effect? Who was appointed as the Agent in the ORIGINAL power of attorney? Enter the name of the person whose power of attorney is being revoked. Did the original power of attorney include an Alternate Agent? YesNo Name of Alternate Agent: When was the original power of attorney signed? What type of decisions will the Agent NO LONGER be able to make? FinancialMedicalMinor (Child)Motor VehicleReal EstateTax Please acknowledge the following requirements: The Principal MUST acknowledge their signature on the revocation before a notary public. The Principal MUST acknowledge their signature on the revocation before a notary public. I understand. The Principal MUST sign the revocation in the presence of two witnesses. The Principal MUST sign the revocation in the presence of two witnesses. I understand. Next Save Save and finish later
