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Tennessee Revocation of Power of Attorney Form

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Tennessee Revocation of Power of Attorney Form is for use when you already have an existing POA, but you wish to cancel or terminate it. The most important thing about terminating a pre-existing POA is to make sure all the relevant people are aware that you have terminated it, including your agent, back-up agent and any institutions that may have the POA on file. You will want to provide a copy of this document to those people once you have filled it out and signed it.

Laws – § 34-6-105

How to Write

1 – The Paperwork On This Page Is A Written Revocation Tool For Principals

The three buttons under the image on this page can be used to access a copy of the Power Revocation form a Principal may use to terminate an Authority he or she previously granted an Agent or Attorney-in-Fact. Download this form then save it to your machine. When it is time to terminate the Granted Authority, fill it out and make it available to the revoked Agent and all concerned entities.

2 – Classify The Previously Granted Powers

The upper left-hand corner of this page will present three checkboxes. Select the checkbox that best defines the type of Powers that have been previously granted. You may classify them as either financial in nature (first checkbox), dealing with Health Care (second checkbox), or as some other type of Powers (third checkbox). If the previously Granted Authority is neither Financial or Health Care, then mark “Other” and record the type of Granted Authority that will be revoked here.

3 – Identify The Grantor, The Document To Be Revoked, And The Terminated Agent(s)

The body of this revocation paperwork will present several areas that require some information to be entered accurately. The first empty line will call for the Grantor’s Legal Name entered on it.

The Title of the paperwork issuing the Granted Authority must be documented on the second empty line of this statement

The Date the Granted Authority will also need to be recorded. This will help identify the document being terminated and should be entered using the three blank lines after the words “…Previously Executed On The”

The next two blank lines will in this paragraph focus upon the Agent and Successor Agent whose Principal Power will be terminated. Utilize the area after the word “…Appointed” to record the Legal Name of each Attorney-in-Fact (or Agent) appointed Principal Power in the previously Granted Authority. If any Alternate Agents are named as back-up Attorneys-in-Fact, then each one must be named using the area just before the term “…As My Alternate Successor Agent.” If there is more than one (of any of these parties), you may continue the Roster on an attachment making sure it is properly labeled and the Name and Role each Agent holds is reported.

4 – The Declaration Of Revocation Must Be Signed To Terminate The Granted Authority

The Principal who has issued and is terminating the previously Granted Authority will need to sign this document, so the Termination may be executed reliably. He or she must locate the last sentence, then enter the current Date utili9zing the three-blank space after the words “…Was Signed The”

As soon as the Grantor enters the Signature Date, he or she must present his or her Signature and Printed Name on the appropriately labeled lines.

The Notary Acknowledgement section has been furnished so the Notary Public present can furnish the items required for this Signing’s Notarization.


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