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Georgia Revocation Power of Attorney Form

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Georgia Revocation Power of Attorney Form is an important document to be used when you wish to cancel or revoke a power of attorney that you created in the past. In order for this form to be effective, you must give a copy to your agent and any financial institution that may have been relying on your power of attorney. A revocation is not effective unless the relevant parties know about it. If a third party has no knowledge of the revocation then he or she cannot be held liable for relying on the authority granted in the original power of attorney.

How to Write

1 – Open The Revocation Form

Obtain a copy of the Authority Document being revoked then, open the Revocation Form using one of the buttons on this page. You may work on it immediately or you may download it then work on it.

2 – Select The Authority Being Revoked

The first step in revoking a previously issued Authority to an Agent is to identify what type of Authority is being terminated. This may be accomplished utilizing the check boxes at the top of this form. If the Authority being terminated or revoked involves Health Care Powers, then mark the first check box. If the Authority being revoked or terminated involves Financial Powers, then mark the second check box. If the Authority in focus is neither of these, then mark the third check box, then define the type of Authority being revoked.

3 – The Principal And The Authority To Be Revoked

The first blank line, in the actual Statement of Revocation, has been provided so the Principal’s Full Name (First, Last, Middle, Title, etc.) may be properly declared. Enter this Name on the blank line after “I.”

Follow the statement until the blank space after the words “…decisions of the document titled,” then, enter the Title of the Authority Document being revoked by this form.

Since the Authority being revoked must be positively identified in this statement, the Authority Execution Date should be recorded using the spaces between the words “…previously executed on the” and “…which appointed.”

Use the blank line between the words “…which appointed” and “as my agent…” to report the Name of the Agent whose Authority is being revoked. The Name of this Agent must appear exactly as recorded in the Authority to be terminated.

Similarly, report the Name of any Alternate or Successor Agent named in the original Authority on the blank line preceding the term “as my alternate successor agent.”

4 – The Validating Signature

The Principal revoking the Authority named in this document, through this document, must sign his or her Name on the line following the words “Signature of Principal.” Below this, the Principal should Print his or her Name.

The next page will allow a Notary Public to provide the notarization seal along with the required verification of the Principal Signing. Only the Notary Public is allowed to provide such items.


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