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Maryland Power of Attorney Revocation Form

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Maryland Power of Attorney Revocation Form should  be filled out and executed if you want to terminate, cancel or revoke a power of attorney that you previously delegated. This form can be used for any type of delegated power that has been issued as a power of attorney. After you fill it out, it is important that you inform your agent and any institutions or other entities that may have been relying on your POA that you have revoked it. If someone relies on the revoked paperwork but has no knowledge of the revocation, they are not at fault.

How to Write

1 – Select The Category Of The Authority Being Revoked

Open this document, one of the three buttons beneath the preview picture of this form. When you are ready to enter information (either onscreen with the appropriate software or manually after you have printed it), begin by categorizing the targeted Authority. This can be done using the three check boxes at the top of the page.

If the Authority being revoked by the Principal gave financial or business Powers to an Agent, then mark the first check box. If the Authority being revoked here gave the Power to make Health Care decisions then mark the second check box.

If the Authority being revoked delivered other Powers to an Agent, then mark the third check box, and describe the type of Authority being revoked using the blank space provided

2 – The Principal Revoking The Previous Authority Must Be Documented

Now, in the first paragraph the individual who issued the previous authority, or the Principal who possesses the Power to revoke the previous Authority must have his or her Legal Name presented on the first blank space.

3 – Detail The Previous Authority Being Revoked By This Document

The rest of this paragraph will supply the necessary wording for the Principal named above to revoke the previous Authority in writing but the document to be revoked must be clearly identified as the target document. This will be done by supplying some basic information from the previously issued Authority onto this document.

First, record the exact Title of the document that must be revoked with this one on the space between the phrase “…of the document titled” and the word “that.”Next, enter the Calendar Date the previous Authority was executed or signed. This should be reported as a Two-Digit Calendar Day (i.e. 1, 2, 3, etc.), the name of the Month, and the Two-Digit Calendar Year on the three blank spaces after the words “…I previously executed on the…”Now, it will be necessary to record the Legal Name of the Agent or Attorney-in-Fact who wields the Authority the Principal intends to revoke here. Enter the Full Name of the Agent to be terminated on the space between the word “…appointed” and the term “as my agent.”Generally, many Power documents will not only name a Primary Agent or Attorney-in-Fact, it will also name a Successor Agent or Alternate Agent as a potential recipient of Power. Enter the Full Name of this individual on the blank space between the word “…and” and the phrase “as my alternate successor agent.”

4 – The Principal Must Date And Sign His Or Her Name

Locate the sentence “This Revocation Was Signed The…” Here, the Principal must use the blank spaces following these words to enter the exact Date he or she is signing this paperwork and therefore revoking the Authority named above. Below the reported Signature Date, the Principal’s Name must be signed and printed on the blank spaces next to the words “Signature of Principal” and “Print Name” respectively.

5 – The Principal Should Notarize This Form

The second page of this template will provide a defined area for the Notary Public to notarize this document with the required information, his or her credentials, and the Notarization Seal.


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