Get Authorized Representative Form

Filling out the Authorized Representative Form online is a straightforward process that allows you to designate a representative to act on your behalf. This guide will provide you with step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to fill out the Authorized Representative Form carefully.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, print your name as the respondent, officer, or employee in the designated field. Ensure it is clear and legible.
3. Next, fill in the name of your company along with the TLC License, Medallion, or Base number in the specified areas. This information is critical for identification purposes.
4. Designate your authorized representative by entering their full name in the corresponding field. This person will act on your behalf regarding your legal matters.
5. In the next field, enter the name of the representative's company, if applicable. This provides additional context for their role.
6. Fill in the street address of your representative. This is where official correspondence may be sent, so accuracy is important.
7. Specify the exact matters you are authorizing your representative to handle, such as adjudication requests or appeals, in the provided space. If this authorization is limited to specific summons, clearly list them.
8. Indicate the effective date of this authorization. It’s essential to ensure it reflects the date you intend for the authorization to begin.
9. By signing the form, you revoke any previous authorizations related to your summons. Place your signature in the designated spot to finalize the document.
10. Once you have reviewed the completed form for accuracy, you can save changes, download, print, or share the form as necessary.

Complete your documents online today for ease and efficiency.