Information Packet - Expedited Title Service Page 4
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5STATE OF FLORIDA
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SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
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POWER OF ATTORNEY FOR A MOTOR VEHICLE, MOBILE HOME OR VESSEL
I hereby name and appoint, __________________________________________________________, to be my lawful
(Full Legibly Printed Name is Required)
attorney-in-fact, to act for me, 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 name and sign their name, in my
behalf. My attorney-in-fact can also do all things necessary to the application or any other related instrument and to
bind me in as sufficient a manner as I myself could do, were I personally present and signing the same.
With full power of substitution and revocation, I hereby ratify and confirm whatever my said attorney-in-fact may lawfully
do or cause to be done in the virtue hereof.
CHECK ONE:
Motor Vehicle
Mobile Home
Vessel
Year
Make/Manufacturer
Body Type
Title Number
Vehicle/Vessel Identification Number
NOTICE TO OWNER: COMPLETE THIS FORM IN ITS ENTIRETY PRIOR TO SIGNING.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT
AND THAT THE FACTS STATED IN IT ARE TRUE.
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_________________________________________________
__________________________________________________
(Signature of Owner / Co-owner "Grantor")
(Legibly Printed Name of Owner / Co-owner "Grantor")
________________________________________________________________________________________________________
(Street Address of Owner / Co-owner "Grantor")
________________________________________________________________________________________________________
(City)
(State)
(Zip)
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(Driver License, Identification Card or FEID Number)
(Date of Birth, 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)
the title is physically being held by the lienholder; or
(b)
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:
HSMV 82053 (Rev. 06/11) S
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