<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><meta http-equiv='content-language' content='en-us'/><title>SDLRC - Codified Law 59-12-43 - Statutory form--Revocation.</title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s2078729Normal { text-indent: 0.50in; text-align: justify; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s2078729SENU { font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2078729CL { font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2078729DefaultParagraphFont { font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.s2078729Normal-000000 { text-indent: 0.00in; text-align: center; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } a.s2078729000001 { text-decoration: none; } span.s2078729000002 { font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.s2078729NoIndent { text-indent: 0.00in; text-align: justify; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s2078729DefaultParagraphFont-000003 { font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2078729SCL { font-style: normal; font-weight: normal; margin: 0; padding: 0; } body { text-decoration-skip-ink: none; } </style></head><body><div><p dir="ltr" class="s2078729Normal"><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=59-12-43"><span class="s2078729SENU">59-12-43</span></a><span xml:space="preserve" class="s2078729SENU">. </span><span class="s2078729CL">Statutory form--Revocation.</span></p><p dir="ltr" class="s2078729Normal"><span xml:space="preserve" class="s2078729DefaultParagraphFont">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 §§ </span><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=43-28-23"><span class="s2078729DefaultParagraphFont">43-28-23</span></a><span xml:space="preserve" class="s2078729DefaultParagraphFont"> and </span><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=7-9-1"><span class="s2078729DefaultParagraphFont">7-9-1</span></a><span xml:space="preserve" class="s2078729DefaultParagraphFont"> apply to any power of attorney that is to be recorded with the register of deeds.</span></p><p dir="ltr" class="s2078729Normal-000000"><span class="s2078729DefaultParagraphFont">SOUTH DAKOTA</span></p><p dir="ltr" class="s2078729Normal-000000"><span class="s2078729DefaultParagraphFont">STATUTORY FORM REVOCATION OF POWER OF ATTORNEY</span></p><p dir="ltr" class="s2078729Normal-000000"><span class="s2078729DefaultParagraphFont">IMPORTANT INFORMATION</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">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</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">that has a copy of the original power of attorney.</span></p><p dir="ltr" class="s2078729Normal-000000"><span class="s2078729DefaultParagraphFont">REVOCATION OF POWER OF ATTORNEY</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">I ________________________________ previously executed a Statutory Form Power of</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">(Name of Principal)</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Attorney with a date of ______________________, 2____ and named the following person as my agent:</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Name of Agent: _________________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Agent's Address: _________________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Agent's Telephone Number: _________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">I also named the following successor agent(s):</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Name of Successor Agent: _____________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Successor Agent's Address: _____________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Successor Agent's Telephone Number: ______________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Name of Second Successor Agent: ___________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Second Successor Agent's Address: _________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Second Successor Agent's Telephone Number: _________________</span></p><p dir="ltr" class="s2078729Normal"><a id="_pagenumber37" class="s2078729000001"></a><span class="s2078729DefaultParagraphFont">I now hereby revoke that Statutory Form Power of Attorney.</span></p><p dir="ltr" class="s2078729Normal-000000"><span class="s2078729DefaultParagraphFont">EFFECTIVE DATE</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">This revocation of power of attorney is effective immediately.</span></p><p dir="ltr" class="s2078729Normal-000000"><span class="s2078729DefaultParagraphFont">SIGNATURE AND ACKNOWLEDGMENT</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">____________________________________________ ______________, 2____</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Your Signature Date</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">____________________________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Your Name Printed</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">____________________________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Your Address</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">____________________________________________</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Your Telephone Number</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">State of ____________________________ )</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">)SS.</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">County of ___________________________)</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">This Statutory Form Revocation of Power of Attorney document was acknowledged before me on _____________________, 2_____ by ___________________________________.</span></p><p dir="ltr" class="s2078729Normal"><span xml:space="preserve" class="s2078729DefaultParagraphFont"> (Date) (Name of Principal)</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">____________________________________________ (Seal)</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">Signature of Notary Public</span></p><p dir="ltr" class="s2078729Normal"><span class="s2078729DefaultParagraphFont">My commission expires:</span></p><p dir="ltr" class="s2078729Normal"><span xml:space="preserve" class="s2078729000002"> </span></p><p dir="ltr" class="s2078729NoIndent"><span xml:space="preserve" class="s2078729DefaultParagraphFont-000003">Source: </span><span class="s2078729SCL">SL 2020, ch 214, § 43.</span></p></div></body></html>