The Utah Power of Attorney Revocation is a crucial document that serves to nullify or cancel a previously granted power of attorney.

This form is essential because it ensures that the principal (the person who granted the power) can maintain control over their affairs and make changes as their circumstances or decisions evolve.

It’s a legal safeguard that protects the interests of all parties involved, ensuring that the agent can no longer act on behalf of the principal once the power is revoked.


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 your intended area.



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: Principal’s Name


Write your full legal name.

This identifies you as the principal who initially granted the power of attorney.



John A. Doe



Step 5: Document Title


Enter the exact title of the previously executed power of attorney document.

This ensures specificity, so there’s no ambiguity about which document you’re revoking.



Step 6: Date


Fill in the day, month, and year when the original power of attorney was executed.

This provides a clear reference point, ensuring that the correct document is identified and revoked.



5th of January, 2020


Step 7: Agent’s Name


Write the full name of the person you initially appointed as your agent.

This confirms the identity of the individual whose powers are being revoked.



Jane B. Smith


Step 8: Alternate Agent


If applicable, write the name of the person you designated as the alternate or backup agent.

This ensures that if you had an alternate agent, their powers are also revoked.



Robert C. Johnson


Step 9: Date


Fill in the day, month, and year when you’re signing this revocation.

This date signifies when the revocation becomes effective.



10th of August, 2023


Step 10: Signature of Principal


Sign your name.

Your signature legally validates and enforces the revocation.



John A. Doe



Step 11: Print Name 



Clearly print your full name.

This ensures legibility and further confirms your identity.



John A. Doe



Part II



Step 1: County



Write the name of the county in Utah where you’re signing the document.

This provides jurisdictional context for the notary acknowledgment.



Salt Lake


Step 2: Date


The notary will fill in the acknowledgment’s day, month, and year.

This confirms the exact date the notary witnessed your signature.



10th of August, 2023



Step 3: Name


The notary will write their name and then your name.

This confirms the notary’s identity and acknowledges that you appeared before them.



Mary D. Lewis, a notary public, personally appeared John A. Doe,


Step 4: Print Name


The notary will print their name for clarity.

This ensures the notary’s name is legible and identifiable.



Mary D. Lewis


Step 5: Expiration Date


The notary will fill in the date their commission expires.

This confirms the notary’s current standing and the validity of their acknowledgment.



15th of March, 2025





The Utah Power of Attorney Revocation is a pivotal document that ensures the principal’s autonomy and the protection of their interests.

By meticulously filling out this form and having it notarized, you’re taking a decisive step to safeguard your rights and ensure that only those you trust have the authority to act on your behalf.

Always consult a legal professional when dealing with such documents to ensure all procedures are followed correctly.