Wisconsin Power of Attorney Revocation Form

In the State of Wisconsin, fulfilling this form cancels any power of attorney granted within the State. The resident’s agent, as well as any concerned financial institution, must be furnished with a copy of this form to notify them of the revocation of the previously granted POA.
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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 immediatel y 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/a ttorney-in-fact to manage my financial affairs.   
  Accordingly, ______________ and ______________, either separately or joi\
ntly, 
have no more power over my financ ial 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 acce ss to information about my financial matters.  
__________________, __________________ and other interested  persons are further notified 
that they will be liable for damages if they ta ke 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 Po wer of Attorney for Finances and 
Property.   
 
-   The letter should also request the ag ent 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 ma ke 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 da te, 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 Re vocation” 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 wr itten 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 lo nger 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 ma iled to me at ___________________________ 
______________________________________________________ by no later  than _________________________.  If you do no t have any records of mine, or 
did not handle any disbursements or expe nses 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 authori zed to handle any financial transactions 
on my behalf.  I have revoked their author ity 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 file s to reflect the fact that _______________ 
and _______________ have no more power ove r my financial affairs.  Neither 
should be granted access to any of my in come or assets, or to any information 
about them, nor may he or she make any d ecisions 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 divert ed by my former agent(s). 
 
  Enclosed please find a copy of th e 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.