Utah Revocation Power of Attorney Form

The following form has to be used if you need to cancel the power of attorney in the State of Utah.

Extracted Text for Proper Search

Revocation of 	Power 	of Attorney	 	Approved Board of District Court Judges January 1	6,  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 	m y  	
powers 	as	 parent or guardian	.  	
(2)	 	I revoke that	 power of attorney 	and assume	 full rights and responsibilities	 o f   a  	
parent or guardian	. 	
Date	 	 	Sign here ►	 	 	
Typed or printed name	 	 	
I certify that __________________________, who is known to me or who presented satisfactory 
identification, has, while in my presence and while under oath or affirmation, voluntarily signed this 
document and declared t	hat it is true.	 	
Date:	 	 	Sign here ►	 	 	
Typed or printed name	 	 	
Notary Seal