Updated January 12, 2023
A New York revocation of power of attorney form can be used to terminate a power of attorney granted to another to act on your behalf. A revocation form may be used to cancel any POA that you may have granted in the past. In addition to filling out and executing this document, you should make sure that your agent and any entity relying on the original POA is aware of the revocation and has a copy. If a third party is not aware of the revocation, then they can still accept the actions of your agent on your behalf without liability.
How to Write
1 – This Page Will Provide A Template To Revoke Authority
This page will supply a preview as well as some buttons for this document. You may use any of these buttons to gain access to a workable copy of this template.
2 – The Category Of Principal Power Being Revoked Must Be Indicated
The first task at hand will be that of categorizing the Principal Powers being revoked. Three check boxes have been provided for this task: Health Care Powers, Financial Powers, and Other. Place a mark in the check box that best applies to the type of Power previously issued. If neither of the first two choices apply, you may select “Other” then define the Power to be revoked on the blank lines supplied in this choice. 
3 – Establish The Principal’s Identity
In most cases, only the Principal who has issued the Powers being revoked may issue this revocation. Enter the Principal’s Legal Name on the first blank space in the main statement.
4 – Declare The Document Being Revoked And The Attorney-in-Fact(s) Involved
The next matter to be discussed will be the previously issued Power Document. In the portion of this statement beginning with “…The Document Titled” we will focus on this previous authority. First, enter the exact Title of the previously issued authority on the blank line furnished after these words.
Then, using the three blank spaces after the term, “…Previously Executed On The” fill in the Execution Date of the previous Authority document to be revoked here (dd/MONTH/YY).
Finally, record the Name of the Primary Attorney-in-Fact on the space prior to the phrase “…As My Agent” and the Name of any Alternate/Successor Agent on the space prior to the term “…As My Alternate Successor Agent.”
5 – The Principal Must Provide A Notarized Signature
The Principal should review this documentation then turn his or her attention to the bottom of the page if it is a true representation of his or her intentions. In the statement beginning with “this Revocation was Signed The,” the Principal must enter the Signature Date he or she is executing and issuing this revocation.
Below this execution Date, the Principal must provide his or her Name as a Signature and in Print.
The last page of this document should be turned over to the Notary Public, so this document may be notarized.