Power of Attorney For A Motor Vehicle, Mobile Home or Vessel
I hereby name and appoint the person listed above, to be my lawful attorney-in-fact, to act for me, in applying for an original or duplicate certificate of title, to register,
transfer title, or record a lien to the motor vehicle, mobile home, or vessel described below, and to print my name and sign their name, on my behalf. My attorney-in-fact can also do all things necessary to the application or any other related instrument and to bind me in as sufficient a manner as I myself could do, were I personally present and signing the same.
With the full power of substitution and revocation, I hereby ratify and confirm whatever my said attorney-in-fact may lawfully do or cause to be done in the virtue hereof.
Owner/Co-Owner Seller Information
This non-secure power of attorney form may be used when an individual or entity appointed as the attorney in fact will be completing the odometer disclosure statement as the buyer only or the seller only. However, this form cannot be used to allow an individual or entity (such as a dealership) to sign
as both buyer and seller for the purpose of disclosing the odometer reading. This may be accomplished
only with the secure power of attorney (HSMV 82995) when:
(a) the title is physically being held by the lienholder; or
(b) the title is lost
NOTE: A licensed dealer and his employees are considered a single entity.
Notary - If Required