Use this form to revoke (remove) Power of Attorney from your agent.

Use this text or use the PDF form that is below the text.

Learn more on our Financial Power of Attorney page.

Instructions for Revoking a Power of Attorney

If you want to end your Agent’s authority to handle your financial business, you should cancel your Power of Attorney. Canceling a Power of Attorney is called a “revocation.”

Your Power of Attorney has not been revoked until your Agent knows that you have ended their authority to act on your behalf. You can revoke the Power of Attorney by telling your Agent they are no longer allowed to handle your affairs. You should also revoke the Power of Attorney in writing. This revocation form will cancel your Power of Attorney. Vermont Legal Aid created this form.

You may not revoke a power of attorney if you have been found incapable of handling your own property or business decisions. While a witness signature is optional, you may want someone to confirm that you are capable of making those types of decisions. A witness (such as a medical provider, a lawyer, or a trusted friend) can sign the document to verify that in their opinion, you are fully capable of managing your own affairs.

Places like your bank also need to know that you have revoked your Agent’s authority. You should send everyone a copy of this written revocation who also has a copy of your original Power of Attorney. They will know your former Agent is no longer allowed to access your financial information or conduct business on your behalf.

The signature of a notary public is also optional. This form revokes a Power of Attorney even if it is not witnessed or notarized.

If you have questions about revocation, call Vermont Legal Aid and Legal Services Vermont at 1-800-889-2047.

REVOCATION OF POWER OF ATTORNEY

I, [Enter your name], of [Enter your town/city], Vermont, hereby revoke any and all Powers of Attorney and all authority to act as my Agent given to (Enter your Agent’s name]. I affirm that I have not been found incapable of making property or business decisions. From this date forward, my former Agent has no authority to handle my property or business affairs. Under 14 V.S.A. §4010(b)(1), my former Agent must comply with this revocation. This document serves as notice of the revocation to the Agent and to all parties that receive it. A photocopy has the same effect as the original.

SIGNATURE OF PRINICPAL

[You sign here]

Date: [Enter date]

(OPTIONAL) SIGNATURE OF WITNESS

I, [Enter witness name here], affirm that the Principal is capable of making property and business decisions.

[Witness signs here]

Date: [Enter date]

(OPTIONAL) SIGNATURE OF NOTARY PUBLIC

At [Notary enters town/city], [Notary enters state],
I [Notary enters their name] acknowledge that the Principal appeared personally before me and signed this Revocation of Power of Attorney.

[Notary signs here]

Date: [Enter date]

My commission number: [Notary enters number]

Expires on: [Notary enters expiration date]