Section 59-12-43 - Statutory form--Revocation

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 DAKOTASTATUTORY FORM REVOCATION OF POWER OF ATTORNEYIMPORTANT INFORMATIONThis 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 companythat has a copy of the original power of attorney.REVOCATION OF POWER OF ATTORNEYI ________________________________ 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:

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 DATEThis revocation of power of attorney is effective immediately.SIGNATURE AND ACKNOWLEDGMENT____________________________________________ ______________, 2____Your Signature Date____________________________________________Your Name Printed____________________________________________Your Address____________________________________________Your Telephone NumberState of ____________________________ ))SS.County of ___________________________)This Statutory Form Revocation of Power of Attorney document was

_________________________________Your Telephone NumberState 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 PublicMy commission expires: Source: SL 2020, ch 214, § 43.