Maryland Revocation Power of Attorney Form

The Maryland Revocation Power of Attorney Form will act as an instrument to terminate a previously issued document transferring authority from a Principal to an Agent. The information recorded on the original document should be transcribed precisely as it was recorded when it is requested on this document. Thus, it will be a good idea to have the original document granting the power of authority being terminated be kept handy as a quick reference when filling out this form.

The Principal must simply complete the document as required and deliver the revocation to the Agent or Guardian and any others who may hold a copy of the powers document. It should be noted, this document must be notarized, once completed, to verify its authenticity.

How to Write

1 – Download the Revocation Form

Use the PDF or Word buttons at the top of this page to obtain a workable copy of the Maryland Power of Attorney Revocation Form

2 – Define the Target of this Document

In order to properly terminate a document that has previously issued authority, this revocation must define the target document type. To do this, select one of the following check boxes listed at the top of the page. Three options are available to define the target document type:

  • Health Care Powers
  • Financial Powers
  • Other  (If choosing “Other,” make sure to enter the Title of the document of authority being terminated on the blank spaces provided)

3 – Supply the Requested Information

The first paragraph will require several items so the required wording it contains will be effective. These piece of information should be entered as accurately as possible:

  • Enter the name of the Principal who is revoking the powers document on the space preceding the wording “[name of agent]”
  • Add the Title of the document to be revoked on the second blank line
  • Enter the date of execution of the document to be revoked in the space following the words “…previously executed on”
  • Provide the name of each Agent, Guardian, or Health Care Agent name that is on the document in the space just before the term “[name of agent]”
  • Provide the name of each Alternate/Successor Agent, Guardian, or Health Care Agent located on the original powers document on the next space

The next paragraph will require the date this document is to be executed. The revocation power of this document will take effect immediately upon signing. Thus, locate the wording “This revocation takes effect…” then define the execution by supplying the following items:

  • Report the Calendar Date this document is to be executed by recording the Calendar Day, on the space following the words “Signed this,” then the Month and Year (of the Signature Date) across the next two spaces

4 – Principal Signature

This document must be signed before a Notary Public. The following items must be supplied:

  • Print the name of the Principal on the first line
  • Enter the Principal’s Signature on the second line

5 – Notary Acknowledgement

After the Notary Public has had the chance to witness the completion of the document and witnessed the signature(s), the Notary shall complete the remainder of the document with the require Notary Public information and shall then affix an official state seal (if any). This will acknowledge the document, it’s information and signatures.