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Mississippi Revocation Power of Attorney Form

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Mississippi Revocation Power of Attorney Form should be implemented when you are seeking to terminate or cancel a previously executed appointment of your principal authority. It is crucial to the success of this document that you inform your agent that he or she may no longer act for you by delivering a signed copy of this paperwork to him or her.  It is also recommended that you make sure any institutions or entities that depend upon the terminated agent to receive your instructions be given a copy of this document as well.

How to Write

1 – Open This Form To Fill Out The Revocation Paperwork Required

You may gain access to the proper paperwork by clicking one of the buttons underneath the photo preview of this form. You may open the form as a Word, PDF, or ODT file when you are ready to supply the requested information.

2 – Classify The Authority Being Revoked

This Revocation will begin with three checkboxes (“Health Care Powers,” “Financial Powers,” and “Other”). Mark the box that best defines the Authority being revoked. If you must mark the box labeled “Other” make sure to provide the classification for the type of Principal Powers being revoked using the blank line after the word “Other.”

3 – Identify The Revoking Principal

Find the first blank space in the Introductory Statement of Revocation, then use it to document the Principal’s Full Name.

4 – Detail The Authority Being Revoked

Use the blank space between the words “…Decisions Of The Document Titled” and the words “that portions…” to transcribe the exact title of the Authority document being revoked. The revoked document must be further identified by its Date of Execution. Locate this Date on the paperwork being revoked then enter it utilizing the three blank spaces after the phrase “…previously executed on them.” Note: Sometimes this will be listed as the Date Of Signature, Date of Effect, or Date of Execution.

5 – Name The Agent(s) Being Terminated

The Principal Authority in the document being revoked will name an Agent or Attorney-in-Fact as the recipient of Principal Power. The next two blank spaces will require the Full Name of this Agent entered just before the words “as my agent…” and the Full Name of the Alternate Agent recorded just before the words “as my alternate successor agent…”

6 – The Principal Must Date And Sign This Revocation

The Principal who is revoking the previous Authority must record the Calendar Date he or she is signing this Revocation, essentially putting it into effect. Just before signing this document the Principal should enter the Calendar Date, Month, and Year of Signing on the three blank spaces after the words “This Revocation Was Signed The”

After entering the current date (Signature Date) the Principal must sign his or her Name on the “Signature Of Principal” line.

Below the Principal’s Signature, the Principal must print his or her name.

7 – The Notary Public Section

The Notary Public is the entity that will notarize the Principal Signing. He or she will supply the County, Date, and the Parties present at the time of this signing. Once these items have been supplied he or she will notarize this document.


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