MISSISSIPPI REVOCATION OF POWER OF ATTORNEY
In Accordance with § 110 of the 2013 MS POA Bill (HB 468) 

I, _______________________ (your name), of ___________________ (your town), Mississippi, hereby revoke any and all Powers of Attorney and all authority to act as my Agent given to _________________________________ (Agent’s name). From this date forward, my former Agent has no authority to handle my personal or financial affairs. Under § 110 (HB 468), my former Agent must comply with this revocation. This document serves as notice of the revocation to the Agent and to all parties that receive it. A photocopy has the same effect as the original.
The foregoing Revocation was signed by ____________________________in our presence, and we, at her request and in her presence, and in the presence of each other, each of us being over the age of 18 years, have hereunto subscribed our names as Witnesses on this the __________ day of ___________________, 20___.

Witness		Witness	
			
Street Address		Street Address	
			
City, State, and ZIP		City, State, and ZIP	
			
STATE OF MISSISSIPPI	
COUNTY OF ____________________	

BEFORE ME, the undersigned authority, on this day personally appeared ____________________________ (principal), who, having been duly sworn, states that she is executing this Revocation in the presence of the two Witnesses as shown above and for the purposes therein expressed.

SWORN TO, SUBSCRIBED AND ACKNOWLEDGED BEFORE ME by _________________ and by the said witnesses _________________________ and _________________________ , on this _____ day of ________________ , 20___ .
	
Notary Public, State of ____________