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Updated July 11, 2022

A West Virginia Revocation of Power of Attorney Form may be utilized when you seek to terminate a power of attorney that you granted to an agent or agents. Generally, most cases where an agent currently wields principal powers that must be terminated will call for an official revocation of the current appointment. This paperwork can be applied to a variety of types of powers of attorney. Naturally, you will want to make certain that your agent and back up agent receive this document in a timely and verifiable manner. Additionally, this paperwork should be sent to every third-party entity that possesses a copy of the original document. After all, the purpose of this document is to notify every relevant party that the principal power of the current agent(s) has been revoked and therefore nullified.

Laws –  § 39B-1-110

How to Write

1 – Download The Power Termination Template

The template featured in the image on this page can act as a Principal tool for Revocation. It may be downloaded using the buttons captioning this preview

2 – Choose The Type Of Principal Power Being Revoked

The Principal Powers that must be revoked should be fully identified in this document. We will begin by classifying them as “Health Care Powers,” “Financial Powers,” or “Other” type of Powers. To report on the Power Category being revoked, mark the appropriate checkbox from the three provided near the top right-hand part of this page. If the Powers that must be revoked are “Other,” then enter the type of Powers they are on the blank line provided 

3 – Name The Principal Issuing This Terminating Paperwork

Once we have classified the Terminated Powers, we must begin supplying some information to the declaration paragraph. Begin by filling out the Name of the Principal on the first blank space.

4 – Identify The Document That Granted Authority

Next, supply the Title of the paperwork that granted the Principal Power this document will cancel or terminate.  The Title of the Power Document will need to be accompanied by its Execution Date. Three spaces are furnished precisely for this purpose. Report this Date on these lines.  Finally, Name each Agent and Successor Agent that has been assigned with the Power through the previous grant on the blank spaces preceding “As My Agent” and “As My Alternate Agent” (respectively). If there is not enough room to present each of these entities continue the Roster on an attachment

5 – The Principal Who Issues This Termination Must Sign It

After this revocation statement will be an additional statement. The sole purpose of this additional statement is to solidify the Date of Signature. This Date will also serve as the official Execution and Revocation Date. To complete this requirement the Principal must locate the blank spaces supplied after the words “This Revocation Was Signed The…” then, use them to record the current Date when he or she signs it. Note: The Principal may not enter a past Date or a Future Date.  The Principal must then Sign this document and print his or her Name utilizing the blank lines labeled “Signature Of Principal” and “Print Name.”

The second page will serve as a tool of Notarization but may only be satisfied by the Notary Public who has been obtained to serve this Principal Signing