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Alaska Revocation of a Power of Attorney Form

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Alaska Revocation of a Power of Attorney Form is a template form that cancels and terminates the arrangments for a previous document where an agent was listed as the financial, healthcare, or any type of other representative acting on behalf of the principal. The form does not void the previous document without submitting the notice to the agent as well as any financial institutions that should be notified of said nullification.

Laws – AS 13.26.620

How to Write

1 – Setting Up The Paperwork

Find the power of attorney document that you would like to cancel and make a photocopy of it. Download the Revocation Form from this page, then either open it with the appropriate program or print it.

2 – Select the Document Being Revoked

Identify the original Power of Attorney form being revoked by select the first, second, or third box at the top of the page. Select the first to cancel Health Care Powers, the second box to cancel Financial Powers, or the third box (“Other”) to provide a more appropriate definition on the blank space available. You may only choose one of these.

3 – Supply the Required Information

Several facts must be reported in the main paragraph. The Name of the Principal revoking authority should be entered on the blank space preceding the words “hereby immediately revoke…”

The second blank space calls for the title of the Power of Attorney being revoked to be transcribed (following the words “…document titled”).

The third, fourth, and fifth blank spaces require the Execution Date of the document being revoked. This must be the exact Signature Date on the Power of Attorney being revoked. Enter the Day, Month, and Year (each in its appropriate space DD/Month/YY)

The sixth space, following “…which appointed,” must have the Name of the Agent whose power is being revoked reported.

The final space, preceding the term “as my alternate successor agent,” requires the Name of the Alternate (or Successor Agent) listed on the original document to be listed. This will also revoke the powers the Alternate Agent may use as per the original declaration.

4 – Sign, Notarize, and Present

To finalize this revocation, the Signature Date must be reported on the blank spaces following the statement beginning with the words “This revocation was signed…”

The Principal Must Sign the blank space labeled “Signature of Principal.”

The Printed Name of the Principal must appear below the Principal’s Signature.

Once the Notary Public has witnessed all signatures, the notary will complete the remaining portion of the form. The document will be acknowledged by affixing their state seal.

Once signed and sealed the form should be given to all institutions that should be notified of the cancellation of the relationship. Most importantly the agent should be submitted notice immediately.


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