Revocation of Health Care Proxy - New York

New York · Fillable PDF · Free

Document the New York health care proxy you are revoking. Follow the packet's notice instructions and inform the health care providers and agent who hold the earlier document. Withdraw a previous health care agent appointment.

Serving New York. New York appointments require New York-commissioned notaries.

Download Revocation of Health Care Proxy - New York PDF · 3 pages. No account required.

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Who this form is for

Withdraw a previous health care agent appointment.
Document the New York health care proxy you are revoking. Follow the packet's notice instructions and inform the health care providers and agent who hold the earlier document.

What you'll need

The original Revocation of Health Care Proxy packet and its instructions.
The names, dates and supporting records needed to withdraw a previous health care agent appointment.
The recipient's requirements and acceptable photo ID if arranging a notarial act.

How to complete it

Download the New York Revocation of Health Care Proxy PDF and read its instruction page.
Enter the requested information to withdraw a previous health care agent appointment; confirm any choices you do not understand with a New York attorney.
Follow this packet's signature, witness and notarization directions. Do not pre-sign a statement that must be signed before the notary.
Save and print your completed copy, then follow the packet's delivery or recording instructions and keep a copy for your records.

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These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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