The West Virginia Revocation of Power of Attorney Form is a crucial legal document that formally allows an individual to cancel a previously granted power of attorney.

This ensures that the designated agent no longer has the authority to act on the principal’s behalf. Such a revocation may be necessary due to changing circumstances, a breakdown in trust, or the principal’s change of mind.

This document provides clarity and ensures the protection of the principal’s interests and rights. It’s a testament to the importance of having control over one’s affairs and the ability to change decisions when deemed necessary.


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: Legal Name


Begin by writing your full legal name. This identifies you as the principal who initially granted the power of attorney. It’s essential to be clear about who is revoking the power to avoid any ambiguity.

Example: I, Jane Elizabeth Doe


Step 5: Document Title


Specify the title of the original power of attorney document you’re revoking. This ensures that there’s no confusion about which document’s powers are being nullified.

Example: document titled “General Power of Attorney for Financial Affairs”


Step 6: Date


Indicate the exact date you signed the original power of attorney. This provides a reference point and further clarity about the document in question.

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


Step 7: Agent


Name the individual you initially designated as your agent. This person was previously granted the authority to act on your behalf.

Example: which appointed Robert James Smith as my agent


Step 8: Alternate Agent


If you had named an alternate agent in the original document, specify their name here. This person would have stepped in if the primary agent could not act.

Example: and Emily Grace Williams as my alternate successor agent.


Step 9: Date


State the date you’re signing this revocation form. It’s a testament to when you made the decision to revoke the power of attorney.

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


Step 10: Signature of Principal 


Sign your name. Your signature affirms your intent and decision to revoke the power of attorney.

Example: Signature of Principal Jane Elizabeth Doe


Step 11: Print Name


Print your full name legibly. This ensures clarity, especially if your signature is hard to decipher.

Example: Print Name Jane Elizabeth Doe



Part II



Step 1: County 


Specify the county where you’re signing this document in West Virginia. This provides jurisdictional context.

Example: County of Jefferson


Step 2: Date


The notary will fill out this section, indicating the date they witnessed your signature and their name.

Example: On this 10th day of August, in the year 2023, before me Notary John A. Brown


Step 3: Print Name


The notary will print their name for clarity.

  • Example: Print Name Notary John A. Brown


Step 4: Expiration Date


The notary will indicate when their commission expires, ensuring they are currently authorized to notarize documents.

Example: My Commission Expires on 15th December, 2025



The West Virginia Revocation of Power of Attorney Form is a testament to the dynamic nature of life and relationships.

It underscores the importance of controlling one’s decisions, even after making them.

By filling out this form diligently and accurately, you ensure that your wishes are respected and that there’s no ambiguity about your intent.

Always consult with legal counsel when dealing with such documents to protect all parties’ rights and interests.