New York Revocation of Power of Attorney

If you would like to revoke a power of attorney in New York state, use this form to let all concerned parties know. Use this form in the following two situations:

  • You want to revoke your power of attorney before the termination date set out in the document.
  • Your power of attorney has ended as specified in the document, but you want to be absolutely sure that all institutions and people who received it know that it is no longer in force.

See below for a full product description.

I, , of , revoke the power of attorney dated , empowering  to act as my agent. I revoke and withdraw all power and authority granted under that power of attorney.

Multiple Selection
Label Contract Text
if applicable That power of attorney was recorded on . The reference number is .

Signed: This __________________________ day of ________________________, ______________.

State of New York County of: ______________________________________

 

Signature: _______________________________________________________, Principal

Social Security number: ____________________________________________

Multiple Selection
Label Contract Text
include notarization

Certificate of Acknowledgment of Notary Public


State of _____________________________________________    )

                                                                                                                            )           ss

County of ___________________________________________     )

 

On _______________ before me, _________________________________________ (here insert name and title of the officer) personally appeared _______________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of ___________ that the foregoing paragraph is true and correct.

                                                            WITNESS my hand and official seal.

                                                            _____________________________________

                                                            Notary Public for the State of ______________

                                                            My commission expires __________________

[NOTARY SEAL]

 

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