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Kentucky Power of Attorney Revocation Form

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Kentucky Power of Attorney Revocation Form should be utilized when a person has a power of attorney he or she wants to revoke. This form can be used for any type of power of attorney. It is important that in addition to filling out and executing this form, the principal also inform his or her agent and any concerned institutions that the previous power of attorney is being revoked. Otherwise, the agent and the institutions are not liable for continuing to behave as per its directives if they do not that it was revoked.

How to Write

1 – Open The Revocation Form By Selecting The File Type Button On The Right

You may use the form available through the buttons on the right to revoke a previous authority, provided the correct information is supplied and the Principal signs the completed paperwork properly. Gather the records for this revocation then open the form by selecting the appropriate button below the image.

2 – Categorize The Previous Authority

At the start of this form will be three checkboxes. Use these to categorize the Authority being revoked. If targeted Authority contains Health Care Powers, then mark the first checkbox. If it contains Financial Powers then mark the second checkbox. If neither of these categories adequately define the Authority to be revoked, then mark the box labeled “Other” and use the blank line to provide a description.

3 – Identify The Issuer Of The Targeted Paperwork

The first statement below the list of categories will contain a blank space after the word “I.” Enter the Full and Legal Name of the Grantor of the Power in the document that will be revoked. Typically, this is the Principal granting Power. Make sure to record this Name precisely as it was reported on the target paperwork.4 – Detail The Previous Authority

The following area of this statement will seek to tighten the definition as to which document of power is being revoked by this one. Start with the blank space after the term “…decisions of the document titled.” Record the Full Name of the Authority Issuance being revoked by this paperwork on this line. Now, on the three empty spaces following the term “…previously executed on the…,” enter the Day, Month, and Year the target paperwork was signed into effect.

Next, it will be necessary to positively identify the Attorney-in-Fact/Agent and Successor Attorney-in-Fact/Agent who was granted Principal Authority by virtue of the targeted Authority Issuance this paperwork will revoke. Use the two blank spaces preceding the words “…as my agent” and “…as my alternate agent.”

5 – Notarize The Principal’s Signing Of This Completed Form

Once this form’s language has been supplemented with the specific information requested, it will be time for the Principal revoking the previous Authority through this paperwork, to sign this paperwork.

First, enter the Date of this Signature using the spaces in the sentence “This revocation was signed the…”The Signature and Printed Name of the Principal must be supplied on the blank spaces labeled “Signature of Principal” and “Print Name” (respectively).

The Notary Public overseeing this signing is the only entity who may fill in the “Notary Acknowledgment” page.

Attach a copy of the revoked document to the form and provide copies of the revocation to your agent as well as other institutions that may have your power of attorney on file.


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