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Utah Revocation Power of Attorney Form


Utah Revocation Power of Attorney Form
Utah Revocation Power of Attorney Form
Revocation of Power of Attorney
Approved Board of District Court Judges January 16, 2009
Page 1 o f 1
Revocation of Power of Attorney
I swear that the following is true:
(1) On ___________________________ (date), I signed a written power of attorney
appointing ____________________________________ (name) the attorney-in-
fact for ____________________________________ (name), delegating my
powers as parent or guardian.
(2) I revoke that power of attorney and assume full rights and responsibilities of a
parent or guardian.
Date
Sign here
Typed or printed name
Date:
Sign here
Typed or printed name
Notary Seal
Utah Revocation Power of Attorney Form