Wisconsin Power of Attorney Revocation Form

This form is used when cancelling a power of attorney form in the State of Wisconsin. It is important that your agent receive a copy as well as any financial institution that be aware of the revocation of your previous power of attorney.

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NOTICE OF REVOCATION OF POWER OF ATTORNEY FOR FINANCES AND PROPERTY 

I, _________________________________________, being of sound mind, do hereby notify _______________________[name of agent], _________________________[name of alternate agent, if any] and other interested persons that I immediately revoke the Power of Attorney for Finances and Property that I previously executed on __________ which had appointed ______________ as my agent/attorney-in-fact to manage my financial affairs, and _______________ as my alternate agent/attorney-in-fact to manage my financial affairs.

Accordingly, ______________ and ______________, either separately or jointly, have no more power over my financial affairs. _____________ and/or _________________ should not be granted access to any of my income or assets, may no longer make any decisions regarding them, and should not be given any access to information about my financial matters. __________________, __________________ and other interested persons are further notified that they will be liable for damages if they take any action under the revoked Power of Attorney after receiving this notice.

This revocation takes effect immediately. A photocopy has the same effect as an original.

Signed this ________ day of ____________________, 200_.

______________________________________________ (signature of principal)

By signing as a witness, I am acknowledging this signature of the principal who signed in my presence and the presence of the other witness, and the fact that he or she has stated that this revocation of his/her power of attorney reflects his/her wishes and is being executed voluntarily. I believe him/her to be of sound mind and capable of creating this revocation. I am not related to him/her by blood, marriage or adoption and, to the best of my knowledge, I am not entitled to any portion of her estate under his/her will.

Witness Witness

Dated: ______________________________ Dated: ______________________________

Signature: ___________________________ Signature____________________________

Print Name: _________________________ Print Name: _________________________

Address: ____________________________ Address: ___________________________

____________________________________ ____________________________________

State of Wisconsin

County of ___________________

This document was acknowledged before me on ____________(date) by___________________.

_________________________________ (Signature of Notarial Officer)

_________________________________ (Title)

My commission is permanent or expires _____________________

STEP TWO: Give Notice to the Agent and Alternate Agent 

1. The notice letter should include the date, your personal information including your name and address, and the personal identifying information of the agent and alternate agent. Find a sample letter below. 

– The letter should also state that you are giving all interested persons notice of your intent to revoke the Power of Attorney for Finances and Property.

– The letter should also request the agent return any documents (checks, bank ledgers, bank statements, tax returns, and so on) to you.

– A separate letter should be sent to the agent and the alternate agent.

2. Sign the letter and make several copies.

3. Mail the letter return and “Notice of Revocation” statement to all persons named in the original return receipt requested. You may also hand deliver the letter and statement. If hand delivered, deliver it only to the named person and get a receipt or written statement signed by the person stating that she or he received the notice.

 

STEP THREE: Give Notice to Financial Institutions 

1. The notice letter should include the date, your personal information, your agent’s personal information, and information about your accounts. Find a sample letter below.

– The letter should include that you are giving the institution notice of your intent to revoke the power of attorney.

– A separate letter should be sent to every financial institution that might have a copy of the original power of attorney document.

2. Sign the letter and make several copies.

3. Mail the letter and the “Notice of Revocation” statement to all persons named in the original return receipt requested. You may also hand deliver the letter and statement. If hand delivered, deliver it only to the named person and get a receipt or written statement signed by the person stating that she or he received the notice.

 

SAMPLE NOTICE LETTER TO AGENT AND ALTERNATE AGENT 

DATE

Name and address of agent

RE: Power of Attorney for Finances

Dear ______________:

Please be advised that I have revoked your authority to handle any financial transactions on my behalf, and you are no longer authorized to handle any financial transactions on my behalf. Please find enclosed a copy of the formal Notice of Revocation.

Under the law, if you fail to comply with this notice, you may be liable to me for damages.

I hereby demand that you turn over all records of mine that are in your possession, and account for all disbursements or expenses made from my assets by you. This information should be mailed to me at ___________________________ ______________________________________________________ by no later than _________________________. If you do not have any records of mine, or did not handle any disbursements or expenses from my assets, you should mail me written confirmation by _____________________.

Sincerely,

Name of Principal

Address of Principal

Enc.

SAMPLE NOTICE LETTER TO FINANCIAL INSTITUTION 

DATE

Name of financial institution

Address of financial institution

RE: Power of Attorney for Finances of _____________ 

Account No. ____________ 

Please be advised that _________________ and _________________, either jointly or separately, are no longer authorized to handle any financial transactions on my behalf. I have revoked their authority and have so notified them. You are not to honor any transactions on my behalf by either of these individuals. Please immediately make a notation in your files to reflect the fact that _______________ and _______________ have no more power over my financial affairs. Neither should be granted access to any of my income or assets, or to any information about them, nor may he or she make any decisions regarding my income, assets or financial affairs.

Under the law, your failure to comply with this notice will render you liable for any assets lost or diverted by my former agent(s).

Enclosed please find a copy of the formal Notice of Revocation.

If you have questions, please call me at ______________.

Thank you for your cooperation in this matter.

Sincerely,

Name of Principal

Address of Principal

Enc.