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POWER OF ATTORNEY TO SIGN FOR OWNER VSA 70 12/01/2010 WHEN REGISTERING AND/OR TRANSFERRING OWNERSHIP OF A MOTOR VEHICLE VEHICLE OWNER S OWNER NAME last first middle CO-OWNER NAME last first middle OWNER STREET ADDRESS CITY CO-OWNER STREET ADDRESS STATE FULL LEGAL NAME last ZIP first STREET ADDRESS VEHICLE MAKE middle BODY TYPE VEHICLE INFORMATION MODEL YEAR VEHICLE IDENTIFICATION NUMBER VIN suffix TITLE NUMBER CERTIFICATION I/We being the owner s of the motor vehicle described above by these presents do make constitute and appoint the person named above true and lawful attorney-in-fact to sign in my/our name place and stead any Certificate of Title or other supporting papers covering said motor vehicle in whatever manner necessary to register and/or transfer ownership of said motor vehicle and I/we do hereby grant unto said attorney-in fact full authority and power to do and perform any and all other acts necessary or incidents to the execution of the powers herein expressly granted as the grantor might or could do if personally present with full power of substitution. I/We further certify and affirm that all information presented in this form is true and correct that any documents I/we have presented to DMV are genuine and that the information included in all supporting documentation is true and accurate. I/We make this certification and affirmation under penalty of perjury and I/we understand that knowingly making a false statement or representation on this form is a criminal violation* OWNER SIGNATURE OWNER SOCIAL SECURITY NUMBER/EMPLOYER FEDERAL ID DATE mm/dd/yyyy NUMBER If vehicle owned by a company or corporation CO-OWNER SOCIAL SECURITY NUMBER/EMPLOYER FEDERAL DATE.

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