Export Power Of Attorney (Page 4 of 4) in pdf

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Date:

I hereby name and appoint

_PLEASE LEAVE BLANK____

___PLEASE LEAVE BLANK_____

to be my lawful attorney-in-fact to act on my behalf to

conduct all transactions necessary with U.S. Customs and Border Protection in the

proper exportation of the below stated vehicle, which is described as:

Year

Make

Model

Color

Body

Vehicle Identification Number

Title

And to do all things necessary to ensure compliance with all regulations pursuant to

Section 192 of the U.S. Customs and Border Protection Regulations.

Signature of Owner

Owners Name – Type or Print

Signature of Co-Owner

Co-Owners Name – Type or Print

Home Address of Owner

City, State, Country

Sworn and subscribed to me the _____ day of __________________, 20______.

PLEASE NOTE THAT WE WILL NOTARIZE AT MMI

Signature of Notary Public

Commission Expires

Personally known ________________

Produced Identification ________________

Type of Identification Produced _____________________________________________________

(Notary Stamp/Seal)

Warning to Notary: All fields must be filed in completely before Notary Stamp or Seal is affixed. Failure to

comply may result in penalties.

Export Power Of Attorney Page 4