Revocation of Power of Attorney 

1. Principal 

I, [Full Name of Principal], residing at [Address], hereby revoke and terminate the following Power of Attorney: 

2. Identifying the Power of Attorney 

• Type of Power of Attorney: [General, Limited, Medical, or other specific type]. 

• Date of Original Document: [Date on which the POA was executed]. 

• Name of Agent: [Full Name of the Agent previously appointed]. 

3. Scope of Revocation 

Effective immediately, the above-referenced Power of Attorney, including any and all authority granted to the Agent, is hereby fully revoked. The Agent named in that document no longer has any power or authority to act on my behalf in any capacity. 

4. Notice 

I will provide a copy of this Revocation to the Agent and any parties (e.g., banks, medical facilities) who have received or relied upon the original Power of Attorney to ensure they are aware of this Revocation. 

5. Governing Law 

This Revocation shall be governed by the laws of the State of [State]. 

6. Signature and Date 

Principal’s Signature: _________________________  

Date: ______________ 

Printed Name: ________________________________ 

(Notarization or Witness Requirements Here)