Hawaii Revocation Of Power Of Attorney
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1HAWAII REVOCATION OF POWER OF ATTORNEY
Use of this form is for the power of attorney of:
❑ - Health Care Powers
❑ - Financial Powers
❑ - Other:
I,
[name of
principal], hereby immediately revoke those portions covering decisions of the
document titled
[add title of
document] that I previously executed on
[date], which had appointed
[name of agent] as my agent and
[name of alternate agent, if any] as my
alternate successor agent. I hereby notify said agent(s) and any other interested persons
that all portions of said document are revoked.
This revocation takes effect immediately. A photocopy has the same effect as an original.
Signed this
day of
, 20
Print name of principal
Signature of principal
NOTE: Provide copies to anyone who may have copies of the Power of Attorney that is
being revoked. Retain the original of this form in your personal papers.
NOTARY ACKNOWLEDGMENT
State of Hawaii )
County of
)
On this
day of
, in the year 20
, before me
, a notary public, personally appeared
, proved on the basis of satisfactory evidence to
be the person(s) whose name(s) (is/are) subscribed to this instrument, and acknowledged
(he/she/they) executed the same.
Witness my hand and official seal.
Pursuant to Hawaii §551E‑51
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