Navigating legal forms can sometimes be daunting. They often serve as a legal safeguard, ensuring clear communication between parties. The Kansas Power of Attorney Revocation Form is no different.

A Power of Attorney (PoA) allows one person to make decisions on behalf of another. There might be situations, however, when the individual granting that power decides to withdraw it.

This is where the Kansas Power of Attorney Revocation Form comes into play. It acts as a document declaring the rescindment of previously given powers, ensuring protection for all parties involved.

Below is a detailed guide to understanding and completing this essential form.


Part I


This title clarifies that the document pertains to Kansas, ensuring that it complies with this state’s specific laws and requirements. Different states may have slightly different rules, so always use the proper form for the appropriate jurisdiction.


Step 1: Health Care Powers


A Power of Attorney could give someone else the authority to make health care decisions on your behalf. This could include decisions about treatments, surgeries, or end-of-life care.



Step 2: Financial Powers


This is where you give someone authority to make financial decisions for you. It could involve managing your bank accounts, selling or buying property, or investing your money.



Step 3: Other


There are many types of powers of attorney – perhaps you gave someone the authority to act on your behalf in another specific matter, like childcare decisions or business operations. This space allows you to define that unique purpose.


Step 4: Full Name


Write your full name in this blank space. Using your full legal name is crucial so there’s no confusion about whose PoA is being revoked.



Step 5: Document Name


Here, you must mention the exact title of the original Power of Attorney document you are revoking. The accuracy ensures that the correct document is identified and rescinded.


Step 6: Date of Original Document


This crucial detail points to the date when the original PoA was signed. By including this, all parties can easily reference the initial document.


Step 7: Agent’s Full Name


By listing out the names of the primary and alternate agents, the form ensures clarity on who the revocation affects. It explicitly identifies and notifies the individuals involved.


Step 8: Date of Revocation


Indicating the date when the revocation is signed helps establish a clear timeline for when the agent’s powers were rescinded.


Step 9: Signature of Principal


This is where you, the individual revoking the PoA, will sign. Your signature gives legal weight to the revocation, making it official.



Step 10: Print Name


Write your name clearly in print. This ensures that even if your signature is hard to decipher, there’s no ambiguity about who revokes the PoA.


Part II


Step 1: Name of the County


For more localized clarity, specifying the county further pinpoints the location where the notarization took place. Different counties within a state might have their own practices or offices dedicated to notarization.


Step 2: Specific Date


Capturing the exact date is crucial to contextualize when the notarization took place, providing a chronological reference point for any future disputes or verifications.


Step 3: Notary’s Full Name


The notary is affirming that they were present and witnessed the individual signing the document. This is central to the role of a notary – ensuring the person signing a document is who they say they are.


Step 4: Signature


The notary’s signature here is vital. They endorse that they followed the correct procedures and verified the signatory’s identity. This, combined with the notary’s seal (or stamp), gives weight and legality to the acknowledgment.



Step 5: Notary’s Printed Name


Having the notary print their name ensures clarity, especially if the signature is hard to read. A legible print name assists in tracing back the notary if any issues arise.

Step 6: Expiration Date


Every notary has a tenure or duration during which they’re authorized to perform their duties. This field is a declaration of when their current commission expires, providing a window of validity for the notarization.



Step 7: Seal


The final touch is the notary seal or stamp, typically imprinted adjacent to the notary’s signature. It’s an additional layer of verification and typically includes unique identifiers like the notary’s name, commission number, and state of operation.




The Kansas Power of Attorney Revocation Form is instrumental in ensuring one’s right to revoke previously given powers. While the process might seem tedious, understanding each field’s significance is vital for safeguarding your intentions.

Always ensure that all details provided are accurate, and consult with legal counsel if you’re unsure about any aspects of the form. With this guide, you’re better equipped to navigate and complete the form confidently.