West Virginia General Durable Power of Attorney for Property & Finances (Upon Disability)

West Virginia General Durable Power of Attorney
for Property & Finances (Upon Disability)

SIGNING & USE GUIDE — READ FIRST, THEN REMOVE BEFORE SIGNING OR RECORDING

West Virginia Statutory Form Power of Attorney (Effective Upon Incapacity)

Built on the statutory form at W. Va. Code § 39B-3-101 (Uniform Power of Attorney Act, W. Va. Code ch. 39B). This guide and the marked packet pages are not part of the statutory form. The power of attorney itself begins on the page titled "STATE OF WEST VIRGINIA — STATUTORY FORM POWER OF ATTORNEY."

(West Virginia Code, Chapter 39B — Uniform Power of Attorney Act)

What this document is

This is the West Virginia statutory form power of attorney for property and finances. It lets you (the "principal") name a person you trust (your "agent") to manage your property and financial affairs. Because it is built on the form the West Virginia Legislature published at W. Va. Code § 39B-3-101, it carries the meaning and effect the Uniform Power of Attorney Act prescribes, and a person asked to accept it must do so on the timetable in W. Va. Code §§ 39B-1-119 and 39B-1-120 (accept, or request a certification, translation, or opinion of counsel, within seven business days; they may not demand a different form).

This document does NOT authorize your agent to make health-care decisions for you. West Virginia health-care decisions use a separate medical power of attorney under the West Virginia Health Care Decisions Act (W. Va. Code ch. 16, art. 30).

Durable — and when it takes effect

This variant is DURABLE and SPRINGING: it takes effect only upon your later incapacity, and it remains effective during that incapacity. West Virginia is a default-durability state (§ 39B-1-104): the power continues through incapacity unless the document says it ends then. The Special Instructions in this form carry the springing statement and name the person you choose to make the written incapacity determination (§ 39B-1-109(b)), with the statutory fallback (§ 39B-1-109(c)) recited.

A springing power is slower to use: before acting, your agent may be asked for a written determination that you are incapacitated. This packet includes a WRITTEN DETERMINATION OF INCAPACITY sheet for the person you named to sign, and a standalone HIPAA authorization so the named determiner, any fallback physician, licensed psychologist, attorney, judge, or governmental official, and your agent can obtain the health information needed — and only for that purpose. (Under § 39B-1-109(d), only the determiner you name in the power of attorney is automatically your HIPAA personal representative.)

Choose a determiner who is NOT your agent. The law permits your agent to make the determination, but the person best placed to certify the event that empowers your agent is someone independent — for example, your physician.

How to complete and sign

1. Fill in your name and your agent's name, address, and telephone number. 2. (Recommended) Name a successor agent, and optionally a second successor, in case your first choice cannot serve. 3. Under GRANT OF GENERAL AUTHORITY, INITIAL each subject you want your agent to handle — or initial "All Preceding Subjects" to grant them all. 4. Under GRANT OF SPECIFIC AUTHORITY, INITIAL only the specific powers you want to give; your agent may NOT do any of those unless you initial it. 5. Read the optional Special Instructions elections and initial ONLY the ones you want. 6. Sign before a notary public or other officer authorized to take acknowledgments (§ 39B-1-105). West Virginia does not require witnesses. Someone else may sign for you only in your conscious presence and at your direction.

Remote notarization: the ordinary path is an in-person acknowledgment before a notary authorized under West Virginia law (W. Va. Code ch. 39, art. 4). West Virginia also authorizes remote online and remote-ink notarization through a qualified notary (§§ 39-4-37 and 39-4-38); if you use one, confirm the notary is authorized for remote acts — the notarial certificate must state that communication technology was used.

Leaving every general-authority line blank gives your agent almost nothing; initialing "All Preceding Subjects" grants the full everyday list. The GRANT OF SPECIFIC AUTHORITY lines are different: each one stays OFF unless you initial it, because those powers can significantly reduce your property or change how it passes at your death.

Compensation of your agent — the West Virginia flip

The form's printed information says your agent "is entitled to reasonable compensation unless you state otherwise." West Virginia's statute reverses that for family: under § 39B-1-112, an agent who is your ancestor, spouse, or descendant is NOT entitled to compensation unless the power of attorney specifically provides it. If your agent is a family member and you WANT them compensated, initial the "Compensation for a family agent" election in the Special Instructions. To bar compensation for any agent, initial the "No compensation" election. Reimbursement of reasonable expenses is not affected by either choice.

If your agent is your spouse

Under § 39B-1-110(b)(3), your spouse-agent's authority ends automatically when an action is filed for dissolution or annulment of your marriage or for legal separation — unless the power of attorney says otherwise. The default is protective: most people want that automatic off-switch. The Special Instructions include an unmarked election to keep a spouse-agent's authority in place despite a filing. CAUTION: that election keeps a soon-to-be-former spouse in control of your property while the case is pending, and the authority continues past the decree until you revoke it (§ 39B-1-110(a)(3)).

Guardianship and conservatorship

You may nominate a conservator of your estate and a guardian of your person for the court to consider (§ 39B-1-108(a); the court considers your nomination under § 44A-2-8). Under § 39B-1-108(b), if a court later appoints a conservator of your estate or another fiduciary over your property, this power of attorney and your agent's authority TERMINATE on the appointment unless the court making the appointment orders otherwise — only the court can continue it. Naming your agent as your nominee for conservator of the estate is the practical way to preserve continuity, and any request for a continuation order must be made before the appointment is entered. After an appointment, your agent must stop acting and must stop signing the agent's certification in this packet (its statement that the power "has not terminated" would no longer be true).

Coagents and successors

The form provides for one agent. To name coagents, say so in the Special Instructions; under § 39B-1-111 coagents may act independently unless you require them to act together. If your agent cannot serve and you named no successor, the power of attorney ends — naming at least one successor is strongly recommended.

Revoking or replacing this power of attorney

Signing a new power of attorney does NOT revoke an earlier one unless the new one says so (§ 39B-1-110(f)). The Special Instructions include an unmarked election revoking your earlier property-and-financial powers of attorney; it is scoped so it cannot touch a health-care power of attorney, a tax authorization, or a single-transaction power. If you are replacing an earlier power, deliver a signed revocation (a form is included in this packet) to every agent and to any bank or other institution that has the old one — a person who acts in good faith without knowledge of a revocation is protected (§§ 39B-1-110(d) and (e)). If you recorded the old power of attorney, record the revocation too, and file the included Notice of Termination with the clerk of the county commission in every county where you own real property (§ 39B-1-119(c)).

Two cautions for this springing variant: revoking an earlier, currently-effective power of attorney leaves NO agent able to act until an incapacity determination is made; and a later immediate power with a revoke-all election would revoke this one.

Recording (real estate)

A power of attorney may be recorded in any county (§ 39-1-1), and the clerk of the county commission shall admit an acknowledged power of attorney to record (§ 39-1-2(a)). Recording is optional under the act, but if you initial "Real Property," expect the clerk and any title examiner to want this power of attorney of record with the deed — record it in the county where the land lies before the transaction. Complete the "This document prepared by" line before recording (§ 39-1-2a). A clerk may refuse double-sided pages or type smaller than 10-point (§ 39-1-11); fees and formatting practice are county-level — call the clerk of the county commission. A recorded notice of termination defeats third-party reliance for real-estate conveyances in that county (§ 39B-1-119(c)), which is why the revocation instructions tell you to file the Notice of Termination.

If a bank or agency hesitates

Because this instrument is substantially the statutory form, West Virginia's acceptance rules apply (§§ 39B-1-119, 39B-1-120): the recipient must accept it or timely request a certification, translation, or opinion of counsel, and may not demand a different form. The AGENT'S CERTIFICATION in this packet (§ 39B-3-102) is the document your agent signs to answer that request; a spare copy is included.

What is in this packet

(1) This guide — remove it before signing. (2) The statutory form power of attorney. (3) The agent's certification, with a spare. (4) A revocation of power of attorney, for later use. (5) A notice of termination for county filing. (6) A written determination of incapacity and a limited HIPAA authorization, for the determination process. Items (3) through (6) are labeled drafting companions prepared by PublicLegal; they are not part of the statutory form.

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STATE OF WEST VIRGINIA

STATUTORY FORM POWER OF ATTORNEY

IMPORTANT INFORMATION

This power of attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). Your agent will be able to make decisions and act with respect to your property (including your money) whether or not you are able to act for yourself. The meaning of authority over subjects listed on this form is explained in the Uniform Power of Attorney Act, §39B-1-101 et seq. of the West Virginia Code.

This power of attorney does not authorize the agent to make health care decisions for you.

You should select someone you trust to serve as your agent. Unless you specify otherwise, generally the agent's authority will continue until you die or revoke the power of attorney or the agent resigns or is unable to act for you.

Your agent is entitled to reasonable compensation unless you state otherwise in the special instructions. This form provides for designation of one agent. If you wish to name more than one agent you may name a coagent in the Special Instructions. Coagents are not required to act together unless you include that requirement in the Special Instructions. If your agent is unable or unwilling to act for you, your power of attorney will end unless you have named a successor agent. You may also name a second successor agent.

This power of attorney becomes effective immediately unless you state otherwise in the Special Instructions.

If you have questions about the power of attorney or the authority you are granting to your agent, you should seek legal advice before signing this form.

DESIGNATION OF AGENT

I, ________________________________________, name the following person as my agent:

(Name of Principal)

Name of Agent: ________________________________________________

Agent's Address: _____________________________________________

Agent's Telephone Number: ______________________________________

If my agent is unable or unwilling to act for me, I name as my successor agent:

Name of Successor Agent: __________________________________________

Successor Agent's Address: _______________________________________

Successor Agent's Telephone Number: ________________________________

If my successor agent is unable or unwilling to act for me, I name as my second successor agent:

Name of Second Successor Agent: ___________________________________

Second Successor Agent's Address: ________________________________

Second Successor Agent's Telephone Number: _________________________

GRANT OF GENERAL AUTHORITY

I grant my agent and any successor agent general authority to act for me with respect to the following subjects as defined in the Uniform Power of Attorney Act, §39B-1-101 et seq. of the West Virginia Code:

(INITIAL each subject you want to include in the agent's general authority. If you wish to grant general authority over all of the subjects you may initial "All Preceding Subjects" instead of initialing each subject.)

(___) Real Property

(___) Tangible Personal Property

(___) Stocks and Bonds

(___) Commodities and Options

(___) Banks and Other Financial Institutions

(___) Operation of Entity or Business

(___) Insurance and Annuities

(___) Estates, Trusts, and Other Beneficial Interests

(___) Claims and Litigation

(___) Personal and Family Maintenance

(___) Benefits from Governmental Programs or Civil or Military Service

(___) Retirement Plans

(___) Taxes

(___) All Preceding Subjects

GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

My agent MAY NOT do any of the following specific acts for me UNLESS I have INITIALED the specific authority listed below:

(CAUTION: Granting any of the following will give your agent the authority to take actions that could significantly reduce your property or change how your property is distributed at your death. INITIAL ONLY the specific authority you WANT to give your agent.)

(___) Create, amend, revoke, or terminate an inter vivos trust

(___) Make a gift, subject to the limitations of the West Virginia Uniform Power of Attorney Act and any special instructions in this power of attorney

(___) Create or change rights of survivorship

(___) Create or change a beneficiary designation

(___) Authorize another person to exercise the authority granted under this power of attorney

(___) Waive the principal's right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan

(___) Exercise fiduciary powers that the principal has authority to delegate

(___) Disclaim or refuse an interest in property, including a power of appointment

(___) Access the content of electronic communications

LIMITATION ON AGENT'S AUTHORITY

An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to benefit the agent or a person to whom the agent owes an obligation of support unless I have included that authority in the Special Instructions.

SPECIAL INSTRUCTIONS (OPTIONAL)

You may give special instructions on the following lines:

SPRINGING EFFECTIVE DATE — This power of attorney becomes effective only upon my incapacity, as defined in W. Va. Code § 39B-1-102(5): I am unable to manage my property or business affairs because (A) I have an impairment in the ability to receive and evaluate information or make or communicate decisions, even with the use of technological assistance, or (B) I am detained (including incarcerated in a penal system) or am outside the United States and unable to return.

DETERMINATION OF INCAPACITY — I authorize the following person(s) to determine in a signed writing that I am incapacitated (W. Va. Code § 39B-1-109(b)):

Name of Determiner: __________________________________

Determiner's Address: ______________________________

Determiner's Telephone Number: _________________________

If each person I named is unable or unwilling to make the determination, my incapacity may be determined in a signed writing as provided in W. Va. Code § 39B-1-109(c): by a physician or licensed psychologist (for the impairment described in clause (A) above), or by an attorney at law, a judge, or an appropriate governmental official (for the circumstances described in clause (B) above). Under W. Va. Code § 39B-1-109(d), the person I named above may act as my personal representative under HIPAA to obtain the health information needed to make that determination; the separate HIPAA authorization included with this power of attorney extends that access as described there.

(___) SPOUSE-AGENT CONTINUATION — If my agent is my spouse, the filing of an action for the dissolution or annulment of our marriage or for our legal separation does NOT terminate my agent's authority (W. Va. Code § 39B-1-110(b)(3)).

Caution: this keeps a spouse's control of your property in place during and after a divorce case until you revoke it. Most people prefer the automatic termination; leave the line blank for that default.

(___) COMPENSATION FOR A FAMILY AGENT — My agent is my ancestor, spouse, or descendant, and this power of attorney specifically provides that my agent is entitled to reasonable compensation for services as agent (W. Va. Code § 39B-1-112).

(___) NO COMPENSATION — My agent is not entitled to compensation for services as agent. This does not affect reimbursement of expenses reasonably incurred on my behalf (W. Va. Code § 39B-1-112).

(___) REVOCATION OF EARLIER POWERS — I revoke every power of attorney for property and finances that I previously signed. This does not revoke any health-care power of attorney or advance directive, any tax authorization, or any power of attorney limited to a specific transaction (W. Va. Code § 39B-1-110(f)).

(___) GOVERNING LAW — The meaning and effect of this power of attorney are determined by the law of West Virginia (W. Va. Code § 39B-1-107).

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

EFFECTIVE DATE

This power of attorney is effective immediately unless I have stated otherwise in the special instructions.

NOMINATION OF CONSERVATOR OR GUARDIAN (OPTIONAL)

If it becomes necessary for a court to appoint a conservator or guardian of my estate or guardian of my person, I nominate the following person(s) for appointment:

Name of Nominee for conservator or guardian of my estate: ____________________

Nominee's Address: _____________________________________________

Nominee's Telephone Number: ____________________________________

Name of Nominee for guardian of my person: _________________________

Nominee's Address: _____________________________________________

Nominee's Telephone Number: ____________________________________

RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that person knows it has terminated or is invalid. Unless expressly stated otherwise, this power of attorney is durable and shall remain valid if I become incapacitated.

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SIGNATURE AND ACKNOWLEDGMENT

_________________________________________________________________

Your Signature ______________________________ Date __________________

Your Name Printed ____________________________________________

Your Address ___________________________________________________

Your Telephone Number __________________________________________

State of ______________________________

County of _____________________________

This document was acknowledged before me on __________________________,

(Date)

by ______________________________________.

(Name of Principal)

____________________________________________ (Seal, if any)

Signature of Notary

My commission expires: ________________________

This document prepared by: ______________________________________

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IMPORTANT INFORMATION FOR AGENT

Agent's Duties

When you accept the authority granted under this power of attorney, a special legal relationship is created between you and the principal. This relationship imposes upon you legal duties that continue until you resign or the power of attorney is terminated or revoked. You must:

(1) Do what you know the principal reasonably expects you to do with the principal's property or, if you do not know the principal's expectations, act in the principal's best interest; act in good faith;

(2) Do nothing beyond the authority granted in this power of attorney; and

(3) Disclose your identity as an agent whenever you act for the principal by writing or printing the name of the principal and signing your own name as "agent" in the following manner:

____________________________ by ______________________________

(Principal's Name) (Your Signature) as Agent

Unless the special instructions in this power of attorney state otherwise, you must also:

(1) Act loyally for the principal's benefit;

(2) Avoid conflicts that would impair your ability to act in the principal's best interest;

(3) Act with care, competence, and diligence;

(4) Keep a record of all receipts, disbursements, and transactions made on behalf of the principal;

(5) Cooperate with any person that has authority to make health care decisions for the principal to do what you know the principal reasonably expects or, if you do not know the principal's expectations, to act in the principal's best interest; and attempt to preserve the principal's estate plan if you know the plan and preserving the plan is consistent with the principal's best interest.

Termination of Agent's Authority

You must stop acting on behalf of the principal if you learn of any event that terminates this power of attorney or your authority under this power of attorney. Events that terminate a power of attorney or your authority to act under a power of attorney include:

(1) Death of the principal;

(2) The principal's revocation of the power of attorney or your authority;

(3) The occurrence of a termination event stated in the power of attorney;

(4) The purpose of the power of attorney is fully accomplished; or

(5) If you are married to the principal, a legal action is filed with a court to end your marriage or for your legal separation, unless the Special Instructions in this power of attorney state that such an action will not terminate your authority.

Liability of Agent

The meaning of the authority granted to you is defined in the Uniform Power of Attorney Act, §39B-1-101 et seq. of the West Virginia Code. If you violate the Uniform Power of Attorney Act, as set forth in §39B-1-101 et seq. of the West Virginia Code, or act outside the authority granted, you may be liable for any damages caused by your violation.

If there is anything about this document or your duties that you do not understand, you should seek legal advice.

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PUBLICLEGAL COMPANION — STATUTORY AGENT'S CERTIFICATION (W. VA. CODE § 39B-3-102); NOT PART OF THE POWER OF ATTORNEY

AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITY

State of ______________________________

County of _____________________________

I, _____________________________________________ (Name of Agent), certify under penalty of perjury that __________________________________________

(Name of Principal) granted me authority as an agent or successor agent in a power of attorney dated ____________________.

I further certify that to my knowledge:

(1) The Principal is alive and has not revoked the power of attorney or my authority to act under the power of attorney and the power of attorney and my authority to act under the power of attorney have not terminated;

(2) If the power of attorney was drafted to become effective upon the happening of an event or contingency, the event or contingency has occurred;

(3) If I was named as a successor agent, the prior agent is no longer able or willing to serve; and

________________________________________________________________________________

(Insert other relevant statements)

SIGNATURE AND ACKNOWLEDGMENT

_________________________________________________________________

Agent's Signature ______________________________ Date __________________

Agent's Name Printed _________________________________________

Agent's Address ________________________________________________

Agent's Telephone Number _______________________________________

State of ______________________________

County of _____________________________

This document was acknowledged before me on __________________________,

(Date)

by ______________________________________.

(Name of Agent)

____________________________________________ (Seal, if any)

Signature of Notary

My commission expires: ________________________

This document prepared by: ______________________________________

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SPARE COPY — USE ONLY IF A BANK OR OTHER INSTITUTION ASKS FOR A FRESH CERTIFICATION LATER

AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITY

State of ______________________________

County of _____________________________

I, _____________________________________________ (Name of Agent), certify under penalty of perjury that __________________________________________

(Name of Principal) granted me authority as an agent or successor agent in a power of attorney dated ____________________.

I further certify that to my knowledge:

(1) The Principal is alive and has not revoked the power of attorney or my authority to act under the power of attorney and the power of attorney and my authority to act under the power of attorney have not terminated;

(2) If the power of attorney was drafted to become effective upon the happening of an event or contingency, the event or contingency has occurred;

(3) If I was named as a successor agent, the prior agent is no longer able or willing to serve; and

________________________________________________________________________________

(Insert other relevant statements)

SIGNATURE AND ACKNOWLEDGMENT

_________________________________________________________________

Agent's Signature ______________________________ Date __________________

Agent's Name Printed _________________________________________

Agent's Address ________________________________________________

Agent's Telephone Number _______________________________________

State of ______________________________

County of _____________________________

This document was acknowledged before me on __________________________,

(Date)

by ______________________________________.

(Name of Agent)

____________________________________________ (Seal, if any)

Signature of Notary

My commission expires: ________________________

This document prepared by: ______________________________________

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PUBLICLEGAL COMPANION — WRITTEN DETERMINATION OF INCAPACITY; SIGNED BY THE NAMED DETERMINER; NOT PART OF THE POWER OF ATTORNEY

WRITTEN DETERMINATION OF INCAPACITY

The power of attorney signed by the principal named below becomes effective only upon the principal's incapacity. In that power of attorney, the principal authorized the undersigned to determine in a signed writing that the principal is incapacitated (W. Va. Code § 39B-1-109(b)).

Name of Principal: __________________________________________

Date of the power of attorney: ________________________________

Name of Agent under the power of attorney: ______________________

DETERMINATION: I have determined that the principal is incapacitated within the meaning of W. Va. Code § 39B-1-102(5) because the principal is unable to manage property or business affairs, on the ground initialled below:

(___) The principal has an impairment in the ability to receive and evaluate information or make or communicate decisions, even with the use of technological assistance (§ 39B-1-102(5)(A)).

(___) The principal is detained (including incarcerated in a penal system) or is outside the United States and unable to return (§ 39B-1-102(5)(B)).

Basis for this determination (brief description): __________________

________________________________________________________________________________

This determination should be kept with the power of attorney and presented with the agent's certification when the agent first acts.

Signature of Determiner __________________________________ Date __________________

Determiner's Name Printed ___________________________________

Determiner's Address ______________________________________

Determiner's Telephone Number _____________________________

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PUBLICLEGAL COMPANION — LIMITED HIPAA AUTHORIZATION FOR THE INCAPACITY DETERMINATION; NOT A MEDICAL POWER OF ATTORNEY; NOT PART OF THE POWER OF ATTORNEY

LIMITED AUTHORIZATION FOR USE AND DISCLOSURE OF HEALTH INFORMATION (INCAPACITY DETERMINATION ONLY)

I signed a West Virginia statutory form power of attorney that becomes effective only upon my incapacity. I make this authorization so the people involved in determining my incapacity can obtain the health information they need for that purpose, and for no other purpose.

Name of Principal: __________________________________________

Principal's Date of Birth: __________________________________

Date of the power of attorney: ________________________________

1. Information that may be used or disclosed

My health records and information, including information spoken to or by my health-care providers, to the extent needed to determine whether I am incapacitated within the meaning of W. Va. Code § 39B-1-102(5).

2. Who may disclose

Any physician, psychologist, hospital, clinic, health plan, or other health-care provider or health-care clearinghouse that has treated me or holds my health information.

3. Who may receive

(a) The person I named in the power of attorney to determine my incapacity (my "determiner"); (b) if my determiner cannot or will not act, a physician or licensed psychologist, or an attorney at law, a judge, or an appropriate governmental official, acting under W. Va. Code § 39B-1-109(c); and (c) my agent under the power of attorney, solely to request and transmit the written determination.

4. Purpose

Solely to determine whether I am incapacitated so that the power of attorney takes effect, and to document that determination.

5. Expiration

This authorization expires when a written determination under the power of attorney has been made, or when I revoke it, whichever comes first.

6. My right to revoke

I may revoke this authorization at any time by a signed writing delivered to my health-care provider, except to the extent a provider has already relied on it.

7. Redisclosure

Information disclosed under this authorization may be redisclosed by the recipient and may no longer be protected by federal privacy rules.

This authorization does NOT give anyone authority to make health-care decisions for me. Health-care decisions in West Virginia require a separate medical power of attorney (W. Va. Code ch. 16, art. 30).

Signature of Principal ____________________________________ Date __________________

Principal's Name Printed _____________________________________

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PUBLICLEGAL COMPANION — REVOCATION OF POWER OF ATTORNEY; USE ONLY TO CANCEL A POWER OF ATTORNEY; NOT PART OF THE POWER OF ATTORNEY

REVOCATION OF POWER OF ATTORNEY

I, ________________________________________, the principal, signed a power of attorney dated __________________

naming ____________________________________________ as my agent.

I REVOKE that power of attorney and the authority of every agent and successor agent named in it, effective immediately. Anyone dealing with my former agent after receiving this revocation should treat the power of attorney as ended (W. Va. Code § 39B-1-110(a)(3)).

Signature of Principal ____________________________________ Date __________________

Principal's Name Printed _____________________________________

State of ______________________________

County of _____________________________

This document was acknowledged before me on __________________________,

(Date)

by ______________________________________.

(Name of Principal)

____________________________________________ (Seal, if any)

Signature of Notary

My commission expires: ________________________

How to use this revocation: (1) Sign it before a notary so it can be recorded (W. Va. Code § 39-1-2 admits acknowledged writings to record). (2) Deliver a copy to every agent and successor agent and to every bank, brokerage, or other institution that received the power of attorney — a person who acts in good faith WITHOUT knowledge of the revocation is still protected (W. Va. Code §§ 39B-1-110(d) and (e)). (3) If the power of attorney was recorded, record this revocation in the same office, and file the NOTICE OF TERMINATION in this packet with the clerk of the county commission in every county where you own real property (W. Va. Code § 39B-1-119(c)).

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PUBLICLEGAL COMPANION — NOTICE OF TERMINATION FOR COUNTY FILING (REAL PROPERTY); NOT PART OF THE POWER OF ATTORNEY

NOTICE OF TERMINATION OF POWER OF ATTORNEY

For filing in the office of the clerk of the county commission of the county named below (W. Va. Code § 39B-1-119(c)).

Name of Principal: __________________________________________

Principal's Address: _________________________________________

Date of the power of attorney being terminated: _________________

Name of Agent under that power of attorney: ___________________

Notice is given that the power of attorney described above, and the authority of every agent and successor agent under it, is TERMINATED. As to any conveyance of an interest in real property located in the county where this notice is filed, a person may not rely on that power of attorney after this notice is filed (W. Va. Code § 39B-1-119(c)).

County where this notice is filed: ____________________________

Signature of Principal ____________________________________ Date __________________

Principal's Name Printed _____________________________________

State of ______________________________

County of _____________________________

This document was acknowledged before me on __________________________,

(Date)

by ______________________________________.

(Name of Principal)

____________________________________________ (Seal, if any)

Signature of Notary

My commission expires: ________________________

How to use this notice: sign it before a notary and file it with the clerk of the county commission in EVERY county where you own real property, after you have revoked the power of attorney. A recorded notice is what defeats third-party reliance for real-estate conveyances in that county (W. Va. Code § 39B-1-119(c)). Recording fees and practice are county-level — call the clerk first.