The Illinois Power of Attorney Revocation Form is an essential legal tool in the landscape of fiduciary relationships. When someone entrusts another individual with the Power of Attorney (POA), they are bestowing upon them the right to make decisions on their behalf.

Over time, situations or preferences may evolve, making it crucial to have a mechanism to withdraw that power. This revocation form exists as a matter of personal choice and as a necessary tool within the legal framework.

By revoking a previously given POA, the principal ensures clarity, avoids potential legal disputes, and protects all parties involved, ensuring that only the desired individuals have the authority to act on their behalf.

Step 1: Name


Enter your full legal name.

This signifies you as the person revoking the power you once granted to someone else.

Example: I, John A. Doe, of,

Step 2: City and County


Mention the city and county where you currently reside.

This ensures clarity about your location and jurisdiction.

Example: The City of Chicago, County of Cook,

Step 3: State


Indicate the state in which you reside.

This will further identify the governing laws and jurisdiction.

Example: State of Illinois



Step 4: Rescind the Specified Power of Attorney Document


Tick or highlight whether it’s a “Property” or “HealthCare” power you’re revoking and insert the date the original POA was made.

It specifies which POA you’re revoking and from when it was in effect.

Example: dated January 1, 2020,


Step 5: Agent’s Name


Mention the full name of the individual you initially designated as your agent in the POA.

Identifying the agent ensures no confusion about who’s being removed from the authority.

Example: Empowering Jane B. Smith to act as my agent.

Step 6: Date


Indicate the current date when completing the revocation form.

This helps determine the exact day you’ve decided to revoke the authority.

Example: Dated: August 13, 2023

Step 7: Signature of Principal


Sign your name.

Your signature validates the document, showing your genuine intent to revoke the earlier granted POA.

Example: [Your handwritten signature here.]


Step 8: State and County


This section will be managed by the notary, but it’ll typically refer to the state and county where the notarization occurs.

This section verifies the notary’s location and lays the foundation for the certification.

Step 9: Date



This section will be completed by the notary. They will input the day, month, and year, followed by their name.

This affirms that you presented the document to a notary on a particular date.


Step 10: Principal’s Name


This section will be filled out by the notary. They’ll pen down your name after they’ve verified your identity.

 It’s an affirmation that you were physically present in front of the notary at the time of the attestation.

Example: personally appeared James L. White,

Step 11: Signature


Here, the notary will provide their official signature.

The notary’s signature is crucial as it attests that they have witnessed the process, confirmed your identity, and everything was in order.

Step 12: State


The notary will indicate the state in which they have the authority to practice.

This affirmation confirms the notary’s legitimate standing and jurisdiction for the process being carried out.

Step 13: Seal


The notary is responsible for placing their official seal here and noting the date when their notary commission will end.

This ensures that the notary is currently licensed and acts as proof of the notary’s active, legitimate status.




In wrapping up, think of this revocation form as a control mechanism, allowing you to retract a decision when circumstances change or doubts arise.

When a Power of Attorney is revoked, proactive communication with the erstwhile agent and relevant bodies with a copy of the POA is paramount.

This proactive step safeguards against potential oversights and misunderstandings down the road.