Free Revocation of a Power of Attorney for Health Care

Revocations of Power of Attorney for Heath Care are necessary in order to revoke those powers previously given to another in regard to decisions about your health care. It will make the original Power of Attorney document null and void.

Disclaimer:This was not drafted by an attorney & should not be used as a legal document.

Revocation of a Power of Attorney for Health Care
I, __________, of __________, by written instrument dated __________, 20____, appointed __________ of __________, my attorney in fact for the purposes and with powers therein set forth under my Power of Attorney for Health Care

Notice is hereby given that I have revoked, and do hereby revoke, the above-described power of attorney, and all power and authority thereby given, or intended to be given, to ______________.

Dated: __________, 20____.

Signed: _________________

STATE OF ____________

COUNTY OF __________

______________________, personally appeared before me this _____ day of ____________, 200___.


Notary Public

My commission expires: ___________________



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