Power Of Attorney Page 4

POWER OF ATTORNEY

Date __________________

I, ________________________________ of ___________________________________,

(Print Name)

(Print Company Name)

hereby issue to the Director of the Division of Motor Vehicle “Power of Attorney” for the

acceptance of service of process.

Signature:

Witness:

________________________________

___________________________________

Sworn and subscribed before me this ______

day of _________________________, 20____.

___________________________________

Notary Public

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Parent category: Legal