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Arkansas Revocation of Power of Attorney Form

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Arkansas Revocation of Power of Attorney Form can be used when you want to cancel a power of attorney that you granted to an agent. This revocation form can be used for any power of attorney that you may have granted including a financial power of attorney, a limited power of attorney, or a health care power of attorney. Make sure that you have provided a copy of this revocation to any institution or person that may have your power of attorney on file. If a third party is not aware of the revocation, then they can still accept the actions of your agent on your behalf.

How to Write

1 – Download The Arkansas Revocation Power of Attorney as a PDF, ODT, or Word File

The required form is obtainable on this page to the right by the file type button below the image.

2 – Specify the Type of Authority Being Revoked

Locate the three checkboxes at the top of this page. Indicate the type of authority being revoked through this Revocation Form by marking the appropriate box

Mark the first check box if the authority being revoked is the result of a Health Care Power of Attorney.

Mark the second check box if the authority being revoked is the result of a Financial Power of Attorney.

If the authority being revoked is the result of another type of power of attorney, then mark the third checkbox and enter the title of the document being revoked.

3 – Identify The Concerned Parties and The Target Authority

The first area requiring attention will be a blank line preceding the term “[name of principal].” Enter the Full Name of the individual who wishes to revoke an authority he or she has previously issued on this line.

Next, after the words “…document titled,” report the Full Title of the target document containing the authority that must be revoked.

On the blank line just after the phrase “…previously executed on,” enter the Execution Date listed on the target document.

Locate the brackets containing the words “name of agent,” then enter the Full Name of the Attorney-in-Fact or Agent as it is recorded on the target document of authority. If there is an alternate agent, report the Full Name of any successive Agent listed on the original authority.

4 – Verify This Revocation

Next, locate the statement beginning with the words “This revocation takes effect…,” then enter the Date of Signature on the following three blank spaces (Day/Mo./Yr.).

The Principal Should Print his or her name on the blank line labeled “Print name of principal,” then must Sign his or her name on the space labeled “Signature of principal.”

The Notary needs to witness you sign the document and confirm with identification that you are the person you say you are. The area below the Principal Signature is solely for the use of the Notary Public.


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