Rhode Island Revocation Power of Attorney Form

The Rhode Island Revocation Power of Attorney Form is a useful document for Principals who have executed a power of attorney that must now be discontinued, terminated, and/or revoked. This form will provide the wording required for a Principal to legally release the Agent or Attorney-in-Fact it is targeting of the authority granted by the power of attorney it names. Such an action must be in the form of a written notice stating the decision and providing verification of authenticity by use of the Principal’s notarized signature. As of the date stated on the revocation form, its presentation will release the Agent from all responsibility and strip this entity of Principal Authority. The document must be delivered or served to the Agent and all other interested parties who hold copy of the previously issued power of attorney or power of authority.

How to Write

1 –Obtain the Paperwork

Use the link below the document image to access the appropriate revocation form

2 -Define the Type of Authority Being Revoked

This document will be aimed at a specific power of attorney that has been previously issued. In the first part of this form mark the check box that defines this authority. Only choose one of the following:

  • Mark the check box titled “Health Care Powers” if the authority being revoked is a Medical Power of Attorney
  • Mark the check box titled “Financial Powers” if the authority being revoked is a Financial Power of Attorney
  • Mark the check box title “Other,” if the authority being revoked is neither a Medical Power of Attorney or Financial Power of Attorney, then enter the Title of the document this revocation targets on the blank line

3 – Provide the Defining Information

The first paragraph will contain some required language but will also require some information to be provided in the blank areas. Make sure this information is identical to that reported on the document being revoked:

  • On the first blank line, report the full Name of the Principal revoking the previously issued Authority
  • On the second blank line transcribe the exact title of the document being revoked
  • On the third blank space of this paragraph, report the Execution Date listed on the target document
  • Locate the term “…which had appointed,” then report the full Name of the Agent (or Attorney-in-Fact) whose Principal Power is being revoked in the space provided
  • Locate the phrase “[name of alternate agent, if any],” then on the space preceding it, report the Name of any and all Alternate or Successor Agents named on the target document

2 – Verify Authenticity of this Document

The Principal, issuing this revocation must read the statement provided then supply his or her verification:

  • Enter the date of the execution of this revocation document  in mm/dd/yyyy format, using the blanks spaces provided in the statement beginning with “This revocation takes effect…”
  • The Principal issuing this document must print his or her name on the space preceding the words “Print name of principal”
  • The Principal must sign the blank space preceding the wording “Signature of Principal”

3 – Notarization

As the Principal has completed the document and the Notary has witnessed the Principal’s signature, the Notary will complete the remainder of the document in acknowledgement and shall affix their official seal