Mississippi Revocation Power of Attorney Form

The Mississippi revocation power of attorney form is a document that is provided for any Attorney In Fact/Agent who has, in the past, completed any form, transferring powers to someone else over their health, finances and/or property, to revoke those powers.

If the Agent wishes now to revoke the Agent’s powers, simply complete the document and deliver it to the Agent, advising them that they are no longer serving the Principal in any way.

How to Write

Step 1 – After the Principal has downloaded the document –

  • Check one or all of the boxes, indicating the powers the Principal would like to revoke
  • Health Care Powers
  • Financial Powers
  • Other (if this box is selected, the Principal must specify the title of the document to be revoked

Step 2 – The Parties –

  • Submit the name of the Principal
  • Enter the title(s) of the powers document(s) to be revoked
  • Provide the commencement date(s) of the/each document being prepared for revocation
  • Enter the names of both the Agent
  • Enter the name of the Alternate/Successor Agent(s)

Step 3 – Specified Date of Revocation-

  • The Principal must enter the date they wish to have recognized as a revocation date in dd./mm/yyyy format

Step 4 – Principal’s Signature – (to only be signed before a notary)

  • Enter the printed name of the Principal
  • Submit the Principal’s signature

Step 5 – Notarization –

Once the Notary Public has witnesses the Principal’s signature, the notary will complete the acknowledgement process, by entering their required information, completing the document and affixing the notary’s official seal