Pennsylvania Revocation Power of Attorney Form

The Pennsylvania revocation power of attorney form is a document that is utilized by a Principal who has authorized powers to an Agent, however, would now like to revoke the powers authorized. With this document, the Principal may revoke a portion or all of the powers. This form must be witnessed by a state notary. The document, once complete must be delivered or served to the Agent. The document cannot be recognized until received by the Agent.

How to Write

Step 1 – Use of the Document –

  • Check the applicable box. If checking “Other,” enter the title of the document to be revoked

Step 2 – The Parties – Enter the following:

  • The name of the Principal
  • Title of the document to be revoked
  • Execution date of the document to be revoked
  • AND
  • Agent’s name
  • Alternate Agent’s name

Step 3 – Date of Revocation –

  • Enter the date of revocation of the titled document in dd/m/yy
  • Principal’s printed name
  • Principal’s signature

Step 4 – Notarization –

  • The Notary will witness the Principal’s signature
  • The remainder of the document shall be completed by the notary

Step 5 – Copies –

  • The Principal should retain the original copy of the document for their records
  • Provide copies to anyone who may possess a copy of the powers document to be revoked