Tennessee Revocation Power of Attorney Form

The Tennessee revocation power of attorney form in this case, is a document that allows the parent(s) or legal custodian of the child(ren) to revoke a previously provided powers document. The document must be completed and signed before a Notary Public. The parent(s) or legal custodian must then either deliver or serve the document to the current Guardian so that they are aware that their powers are revoked. The child(ren) may then be returned, legally to the parent(s) or legal custodian. This document will be in compliance with any previously executed minor child powers form.

How to Write

Step 1 – Part I – Must be completed by parent(s) of the child(ren):

  • Minor Child’s Name
  • Mother/Legal Guardian’s Name & Address
  • Father/Legal Guardian’s Name & Address
  • Caregiver’s Name & Address

Step 2 – Part II – Parent(s) must complete the following:

  • Enter the parent(s) name(s)
  • Provide the date that the powers document was executed
  • Submit the name of the current caregiver

Step 3 – Notarization – All signatories must be present:

  • Provide the name of the County where the document was executed
  • Enter the Mother’s or Legal Custodian’s signature
  • Date the signature in mm/dd/yyyy format
  • The Notary Public will complete the notarization of this information
  • AND
  • Enter the name of the County where the document had been executed
  • Enter the Father’s or Legal Custodian’s signature
  • Date the signature in mm/dd/yyyy format
  • The Notary Public will complete the notarization of this information separately from the previous signature and shall affix their official seal in acknowledgement of all required signatures