DOCUMENT REVOKING GENERAL POWER OF ATTORNEY

KNOW ALL PERSONS BY THESE PRESENTS:  

        That I, ________________________ (YOUR NAME), of ___________________________ (YOUR ADDRESS), Connecticut, hereby REVOKE in all respects, the General Power of Attorney granted by me to _________________________________________ (name), of ______________________ (address) and ____________________________________ (name), of ______________________ (address), on _______ (date of revoked Power of Attorney).

        IN WITNESS WHEREOF, I have hereunto set my hand and seal at __________________, Connecticut, this _______ day of ______________, 20___.  
 

 
Signed, sealed and delivered in the presence of:  

First Witness:
___________________

Second Witness:
___________________

 L.S. (Signature):
_______________________

Your Name:
________________________

 
STATE OF CONNECTICUT)  
                    ) ss.: (town) ____________; _______ ,20__  
COUNTY OF __________)  

            Personally appeared _______________, signer and sealer of the within and foregoing instrument and acknowledged the same to be his/her free act and deed, before me.  
  
                                                 ________________________________ 

                           Commissioner of the Superior Court  
                           Notary Public  
                           My commission expires:

 

 

 

 

INSTRUCTIONS FOR SIGNING 
DOCUMENT REVOKING POWER OF ATTORNEY 

ARRANGE FOR: 

  • TWO ADULT WITNESSES; AND
  • A NOTARY PUBLIC, CONNECTICUT ATTORNEY,  OR: (1) judge of court of record or a family support magistrate; (2) clerk or deputy clerk of a court having a seal; (3) commissioner of deeds or town clerk; or (5) justice of the peace.

TO BE PRESENT DURING THE SIGNING 

  • The notary or other person taking your “acknowledgment” may be one of the witnesses.
  • Toward the top, print your name on the line beginning "That I."
  • Print your town and state of residence after the word "of."
  • Fill in the names and addresses of the individuals named as your power of attorney, and whose appointment you revoke.
  • You should "cross out" unused lines.
  • Iinsert the date on the line beginning "IN WITNESS WHEREOF."
  • On the line labeled "L.S.," sign your name and print your name under the line.
  • Each of TWO witnesses must sign on one of the two lines labeled "Witness," and should print his or her name under the signature.
  • The notary, Connecticut attorney, etc. should ask you if the document is your "free act and deed," fill in the town and date of signing, fill in your name, sign on the line provided, and write in when his or her commission expires (if a notary).  If a notary or clerk with a seal, the seal should be embossed onto the document.  If a Connecticut attorney, no seal is required.