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HSMV 96440 06/11 Page 2 Federal Identification Number Section 6. Signature of Registrant/Licensee The Power of Attorney is not valid until it is signed and dated by the Registrant/Licensee. Division of Motorist Services Bureau of Commercial Vehicle and Driver Services POWER OF ATTORNEY and Declaration of Representative DMS USE ONLY A photocopy of the Registrant s Driver License must be submitted with this Power of Attorney. PART 1 POWER OF ATTORNEY Section 1. Registrant/Licensee Information* Registrant/Licensee must sign and date this form in section 1 and section 6. See Page 2 Section 6 Registrant/Licensee Name and Address as shown on Cab Card or IFTA License Signature of Applicant Print Name Federal ID No* s SSN FEIN etc Registrant Telephone Number Fax Number Hereby appoints the following representative as attorney-in-fact Section 2. Representative. Representative must sign and date this form* See Page 2 Part II Name and Address of person or company being appointed as Power of Attorn....

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How to fill out the FL HSMV 96440 online

The FL HSMV 96440 is a Power of Attorney and Declaration by Authorized Agent form that allows a representative to act on behalf of a registrant or licensee concerning their International Registration Plan (IRP) and International Fuel Tax Agreement (IFTA) accounts. This guide provides clear instructions to help users fill out this form online efficiently.

Follow the steps to complete the FL HSMV 96440 online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. In Section 1, enter the name and Federal Employer Identification Number (FEIN) that match those on your IRP and IFTA accounts. Make sure to input your IRP account number, telephone number, and email address accurately.
  3. Proceed to Section 2 to fill in the details of the authorized agent. Specify whether the agent is an individual or a motor carrier service provider company. Provide the agent’s name, address, main telephone number, fax number, and email address.
  4. In Section 3, include a photocopy of the Registrant/Licensee’s driver license. Then, affirm your authorization for the agent to access and process transactions related to your IRP and IFTA accounts. Write your signature, title, and the date in the designated places.
  5. Complete the notary section to validate the form. This includes having the notary public sign and date the section, confirming your identity.
  6. In Part II, the authorized agent must declare their understanding of the power granted in the form. They should provide their printed name, signature, and date.
  7. Finally, review all sections for accuracy. Save changes, and you can choose to download, print, or share the completed form as needed.

Start filling out the FL HSMV 96440 online today to ensure your representation is properly established.

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