Revoking A Power Of Attorney For Finances Page 2
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1
2
3The Coalition of
Wisconsin Aging Groups is
a nonprofit, nonpartisan,
statewide membership
organization that was
founded in 1978.
REVOCATION OF POWER OF ATTORNEY FOR FINANCES
I, ______________________________________________________ [name of principal], hereby
immediately revoke the Power of Attorney for Finances that I previously executed on
___________________ [date] which had appointed
______________________________________________________ [name of agent] as my financial power of
attorney agent and _________________________________________________ [name of alternate agent, if
any] as my alternate financial power of attorney agent. I hereby notify said agent or agents and any other
interested persons that said power of attorney for finances is revoked.
This revocation takes effect immediately. A photocopy has the same effect as an original.
Signed this _________ day of __________________, 20____
__________________________________________________
Print name of principal
__________________________________________________
Signature of principal
Witness
Witness
Dated: __________________________________
Dated: _________________________________
Signature: _______________________________
Signature: _______________________________
Print Name: ______________________________
Print Name: _____________________________
Address: _________________________________
Address: ________________________________
______________________________ ___
________________________________
State of Wisconsin
County of ___________________
This document was acknowledged before me on ____________(date) by___________________.
_________________________________________ (Signature of Notarial Officer)
_________________________________________ (Title)
SEAL
My commission is permanent or expires _____________________
2850 Dairy Drive, Suite 100
Madison, WI 53718-6742
Telephone: (608)224-0606
Toll Free: 1-800-488-2596
Fax: (608)224-0607
09/2010
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