Updated June 07, 2023
A North Carolina revocation of power of attorney form is a document that can terminate or cancel a power of attorney appointment. It is important that in addition to signing this document, you provide copies of it to your agent and back up agent as well as any institutions or entities that may be using your POA. A person without notice of the revocation is not liable for continuing to use the POA.
How to Write
1 – Download The Revocation Form Supplied On This Page
The paperwork required to revoke a Power of Attorney (currently in Effect) can be viewed and downloaded by clicking any of the three buttons under the preview image. Download this form as a PDF, MS Word, or ODT file and open it when you are ready to fill it out.
2 – The Principal And The Document Being Revoked Must Be Documented
Several empty spaces will be presented throughout this document. It will be up to the Preparer to furnish these pieces of information where necessary. First, the North Carolina County where this paperwork is being Signed, Executed, and Notarized should be recorded on the empty line after the words “County Of” near the top left-hand corner of the page. 
Locate the opening phrase “Know All Men By These Presents, That, I” and use the empty line immediately following it to document the Principal’s Full Name. This name should be entered exactly as it appears on the Power of Attorney paperwork this document will revoke. 
Next, supply the Attorney-in-Fact’s Full Name between the phrase “…Granted By Me, As Principal, To” and “…As Attorney-in-Fact, Which Said Power Of Attorney.” This is the individual whose use of Principal Power must cease upon this document’s execution. 
The Execution Date listed on the Power Document to be revoked must be supplied using the three blank areas provided following the term “…Was Conferred By Me By Instrument Dated The.” Enter this Date in the order of Calendar Day, Month, and Year using these spaces. 
Finally, to finish the report on the Power Document to be revoked, record the County where it was executed on the blank space preceding “County Register Of Deeds Office, North Carolina.”
3 – A Notary Public Must Oversee The Principal Signing
In order to properly Execute this Revocation, the Principal must supply a Dated and Notarized Signature under the observance of a Notary Public. First, in the statement “In Testimony Whereof…” enter the Date this Revocation is being Executed and Signed by supplying the Calendar Day, Month, and Year on the blank spaces provided. 
Below the Execution Date, the Principal must supply a seal by signing his or her Name under the direction of the Notary Public.
The final area will be tended to by the Notary Public. It cannot be filled out by the Principal or any other party that is not notarizing this document.