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Get FL HSMV 82053 2011

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTORIST SERVICES SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE www. flhsmv*gov/offices/ POWER OF ATTORNEY FOR A MOTOR VEHICLE MOBILE HOME OR VESSEL Date I/We hereby name and appoint to be my/our Full Legibly Printed Name is Required lawful attorney-in-fact to act for me/us 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/our name and sign their name in my/our behalf* My attorney-in-fact can also do all things necessary to the application or any other related instrument and to bind me/us in as sufficient a manner as I/we myself/ourselves could do were I/we personally present and signing the same. With full power of substitution and revocation I/we hereby ratify and confirm whatever my/our said attorney-in-fact may lawfully do or cause to be done in the virtue hereof* CHECK ONE Year Motor Vehicle Make/Manufacturer Mobile Home Body Type Vessel Title Number Vehicle/Vessel Identification Number NOTICE TO OWNER S COMPLETE THIS FORM IN ITS ENTIRETY PRIOR TO SIGNING* UNDER PENALTIES OF PERJURY I/WE DECLARE THAT I/WE HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE* Signature of Owner Grantor Legibly Printed Name of Owner Grantor Driver License Identification Card or FEID Number for Owner Date of Birth for Owner if applicable Owner s Address City State Zip Signature of Co-Owner Grantor if applicable 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 b the title is physically being held by the lienholder or the title is lost. NOTE A licensed dealer and his/her employees are considered a single entity. Check your local phone book government pages or visit the following website for current mailing addresses http //www. flhsmv*gov/offices/ POWER OF ATTORNEY FOR A MOTOR VEHICLE MOBILE HOME OR VESSEL Date I/We hereby name and appoint to be my/our Full Legibly Printed Name is Required lawful attorney-in-fact to act for me/us 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/our name and sign their name in my/our behalf* My attorney-in-fact can also do all things necessary to the application or any other related instrument and to bind me/us in as sufficient a manner as I/we myself/ourselves could do were I/we personally present and signing the same. With full power of substitution and revocation I/we hereby ratify and confirm whatever my/our said attorney-in-fact may lawfully do or cause to be done in the virtue hereof* CHECK ONE Year Motor Vehicle Make/Manufacturer Mobile Home Body Type Vessel Title Number Vehicle/Vessel Identification Number NOTICE TO OWNER S COMPLETE THIS FORM IN ITS ENTIRETY PRIOR TO SIGNING* UNDER PENALTIES OF PERJURY I/WE DECLARE THAT I/WE HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE* Signature of Owner Grantor Legibly Printed Name of Owner Grantor Driver License Identification Card or FEID Number for Owner Date of Birth for Owner if applicable Owner s Address City State Zip Signature of Co-Owner Grantor if applicable 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. .

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