The New Hampshire Revocation Power of Attorney Form is a crucial document. This form is essential when one desires to revoke a previously granted Power of Attorney.

Such revocations might be needed due to changes in personal or professional circumstances, ensuring that legal decisions align with your current wishes.

Submitting this form protects both parties by clarifying any changes in the arrangement, thus maintaining trust and transparency.


Part I


In this section, you’re given a clear choice regarding the specific domain for which you’re revoking power of attorney. This aims to provide clarity and specificity, ensuring that the revocation only applies to the area you intend.



Step 1: Health Care Powers


Select this if you’re revoking the authority for someone to make healthcare decisions on your behalf. This can encompass decisions like medical treatments or end-of-life choices.



Step 2: Financial Powers


This pertains to any financial decisions or transactions. By ticking this, you’re ensuring that the said individual will no longer have the authority to handle your financial matters.



Step 3: Other


Other specific powers might not be mentioned in the first two options. In such cases, you can manually specify what they are.


Step 4: Your Name

This is where you’ll insert your full legal name. This establishes you as the principal who initially granted the Power of Attorney.

It’s of utmost importance to ensure your name matches all previous legal documents to ensure no confusion regarding identity.

Example: I, John A. Doe,…


Step 5: Title of the Document Being Revoked

Enter the exact title of the Power of Attorney document you’re revoking. This specificity ensures no ambiguity about which document’s powers are being withdrawn.

Example: …the document titled “Medical Power of Attorney for John A. Doe”,…


Step 6: Date


Indicate the exact date when the original Power of Attorney was executed. This identifies the document and emphasizes that you know when you granted the authority.

Example: …I previously executed on the 5th of May, 2020…


Step 7: Original Agent’s Name


Input the full name of the person you initially granted the power. This reinforces clarity on who was previously entrusted with the authority.

Example: …which appointed Jane B. Smith as my agent…



Step 8: Alternate Successor Agent’s Name


Mention the name of the alternate or successor agent if you had appointed one. This person would have had the power if the primary agent could not act.

Example: …and Robert C. Brown as my alternate successor agent.



Step 9: Date of Revocation Signing


Write the date on which you’re signing the revocation. This is significant as it pinpoints when the revocation becomes effective, ensuring all parties are on the same page.

Example: This revocation was signed on the 10th of August, 2023.



Step 10: Signature of Principal


By signing here, you, as the principal, legally authenticate the document. Your signature signifies your genuine intent to revoke the previously granted powers.

Example: Signature of Principal John A. Doe



Step 11: Printed Name of Principal


This is for clarity and to prevent misinterpretation of your handwritten signature.

Example: Print Name John A. Doe



Part II


Notary Acknowledgment Section


This section gives the form its legal weight. A notary public verifies the signer’s identity, ensuring that the person revoking the Power of Attorney is the principal.


Step 1: County


 Specify the county in New Hampshire where this form is being notarized.



Step 2: Day, Month, and Year of Notarization


The Notary will mark the date they’ve verified the form.



Step 3: Notary’s Name


The name of the notary public verifying the revocation.



Step 4: Principal’s Name (by Notary)


Reiteration of the principal’s name for clarity.



Step 5: Notary’s Signature


The Notary’s signed confirmation.



Step 6: Printed Name of Notary


For clarity, avoid potential signature misreads.



Step 7: Notary’s Commission Expiry Date


Displays the validity of the Notary’s license.




The New Hampshire Revocation Power of Attorney Form acts as a safeguard, allowing individuals to adapt to changes in life circumstances by revoking previously granted powers.

Just as setting up a Power of Attorney requires careful consideration, so does its revocation.

It ensures that only the desired individuals have authority over crucial decisions, reinforcing autonomy and ensuring peace of mind.

Always consult with legal counsel to ensure complete understanding and appropriate usage of this form.