The Florida Power of Attorney Revocation form is a crucial legal document that helps ensure your autonomy and safeguards your interests. It allows you to withdraw the powers you had once granted to someone else through a Power of Attorney (POA).

These powers could be related to health care, financial decisions, or any other areas of life where you may have needed assistance. This form is the brakes to a moving vehicle, granting you the ability to halt any POA powers when they’re no longer needed or if circumstances change.

It’s a valuable tool, not just for you, but also for the agent(s), as it clearly defines when their authority ends, protecting all parties from any future legal complications.


Part I


Here you’ll select the type of power of attorney you’re revoking. This could be a document that was previously used to assign decision-making authority to someone else in case of your unavailability or incapacity.



Step 1: Health Care Powers


This indicates you’re revoking a Health Care Power of Attorney. This type of POA is like handing over the keys of your health decisions to someone else.


An example is when you give someone authority to make medical decisions on your behalf if you’re unable to do so.



Step 2: Financial Powers


Checking this box implies you’re revoking a Financial Power of Attorney.


Imagine you’re going on an extended trip without internet, and you give a trusted person the ability to manage your bank accounts in your absence—that’s this type of POA.



Step 3: Other


If the power you’re revoking doesn’t fall under the health care or financial categories, specify the type here.


For instance, you might have given someone the authority to make decisions about your real estate properties.


Step 4: Name


In the first blank, insert your name, like “John Doe.” The second blank is for the title of the document where you gave power of attorney.


For instance, it could be “Healthcare Power of Attorney for John Doe.”



Step 5: Date



Here, you’ll put the exact date you signed the original POA document. This is crucial as it identifies the specific document you’re revoking.


Think of it like referencing the expiration date on a credit card—it’s your way of showing which document you’re “canceling.”



Step 6: Agent’s Name


In the first blank, you’ll include the name of the individual who was originally given power of attorney—say, your best friend, “Jane Smith.” In the second blank, list the name of the alternate or backup agent, if applicable.


This could be a second trusted person, “Robert Johnson,” who’d step in if Jane couldn’t act on your behalf.



Step 7: Date


Here, you’ll insert the date you’re signing the revocation form. This stamp in time shows precisely when you decided to pull back your power of attorney—like keeping a receipt of when you canceled a service.



Step 8: Signature of Principal & Print Name



In these fields, you’ll sign your name and then print it. It’s like signing a check and printing your name underneath so people can read it. Your signature is your seal of approval on the revocation.



Step 9: Witness’s Signature & Address



Next, each witness will sign their name and provide their address. This is like when you throw a party, and the doorman checks everyone who comes in.


They’re there to confirm, “Yes, this person did sign this document.” The witnesses’ addresses are collected in case any follow-up is necessary later.



Part II


The notary acknowledgment is a formal declaration before a notary public that verifies you freely and willingly signed the document.

Think of a notary as the referee in a football game. They don’t play the game but are there to enforce the rules—ensuring everything is legitimate.



Step 1: County


Enter the county where you sign the document.


e.g., “Miami-Dade.”



Step 2: Date



Here, the notary public will tick how they verified your identity (in person or online), and fill in the date and your name.



Step 3: Signature


The notary will sign, print or stamp their name.



Step 4: Identification


Here, the notary will mark whether they know you personally or if they verified your identity using an identification document.



Step 5: Type of Identification Produced


If identification were used to verify your identity, the notary would record the type of ID presented.


“Driver’s License.”




Understanding and properly completing the Florida Power of Attorney Revocation form is a vital part of maintaining control over your personal affairs. It’s not simply a piece of paper; it’s an assertive statement about who has the right to act on your behalf.

Completing this form helps you, the principal, ensure that your wishes are followed while offering protection for the agent(s) by clearly stating when their powers have ceased.

By revoking a POA, you’re taking a responsible step in managing your own affairs, demonstrating your autonomy, and ensuring the decisions about your life remain firmly in your hands.