59-12-43. Statutory form--Revocation.

A document substantially in the following form may be used to create a statutory form revocation of power of attorney that has the meaning and effect prescribed by this chapter. The provisions of §§ 43-28-23 and 7-9-1 apply to any power of attorney that is to be recorded with the register of deeds.

SOUTH DAKOTA

STATUTORY FORM REVOCATION OF POWER OF ATTORNEY

IMPORTANT INFORMATION

This revocation of power of attorney revokes a previously executed power of attorney including any nominations of guardian or conservator made within that instrument. This revocation does not revoke any power of attorney authorizing the agent to make health-care decisions for you. You should immediately deliver copies of this revocation to any person, institution, or company

that has a copy of the original power of attorney.

REVOCATION OF POWER OF ATTORNEY

I ________________________________ previously executed a Statutory Form Power of

(Name of Principal)

Attorney with a date of ______________________, 2____ and named the following person as my agent:

Name of Agent: _________________________________

Agent's Address: _________________________________

Agent's Telephone Number: _________________________

I also named the following successor agent(s):

Name of Successor Agent: _____________________________

Successor Agent's Address: _____________________________

Successor Agent's Telephone Number: ______________________

Name of Second Successor Agent: ___________________________

Second Successor Agent's Address: _________________________

Second Successor Agent's Telephone Number: _________________

I now hereby revoke that Statutory Form Power of Attorney.

EFFECTIVE DATE

This revocation of power of attorney is effective immediately.

SIGNATURE AND ACKNOWLEDGMENT

____________________________________________ ______________, 2____

Your Signature Date

____________________________________________

Your Name Printed

____________________________________________

Your Address

____________________________________________

Your Telephone Number

State of ____________________________ )

)SS.

County of ___________________________)

This Statutory Form Revocation of Power of Attorney document was acknowledged before me on _____________________, 2_____ by ___________________________________.

(Date) (Name of Principal)

____________________________________________ (Seal)

Signature of Notary Public

My commission expires:

Source: SL 2020, ch 214, § 43.