Power Of Attorney Form
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Power of Attorney
Application Instructions
Only to be used to designate power of attorney to make application for a Certificate of Title, obtain or renew
vehicle registrations, or complete a Report of Sale and/or a Seller’s Permit.
Let it be known that the undersigned:
Write Your Name(s) Here
of the city of Box Elder, South Dakota, does (do) hereby appoint the following true and lawful attorney(s) for
the purpose listed below:
Name of Person(s) Appointed
Street Address / State / City / Zip Code
Americas Mailbox Inc
514 Americas Way, Box Elder SD 57719-7600
Attorney Powers
The appointed attorney(s) may exercise the following designated powers. (Check all that apply)
G
1—T
.
ROUP
O BE USED ONLY IF MORE THAN ONE PERSON IS NAMED ABOVE
Jointly (both owners named must sign)
Check The Appropriate Box or we will fill in for you
Check The Appropriate Box or we will fill in for you
Severally (either owner named can sign)
G
2—O
.
Check The Appropriate Boxes or we will fill in for you
ROUP
NE OR MORE SELECTIONS MUST BE MADE
To apply for a Certificate of Title for the described vehicle/boat in the name of the undersigned.
To obtain original title from lienholder for the described vehicle/boat on behalf of the undersigned.
To obtain or renew the vehicle’s registration for the described vehicle/boat in the name of the undersigned.
To assign all right, title and interest in the described vehicle/boat on behalf of the undersigned.
Vehicle/Boat Description
Americas Mailbox Will Fill In ALL This Information for you.
DESCRIBED VEHICLE OR BOAT
Year _____ Make _______________ Model _______________ VIN# _____________________________ Title# _________
DESCRIBED VEHICLE OR BOAT
Year _____ Make _______________ Model _______________ VIN# _____________________________ Title# _________
Fill In Names Completely And Have Notarized.
Disclosure, Signature and Notary Public Section
If It Is NOT Notarized Properly, We Can Do Nothing.
The undersigned does further authorize said attorney(s) to include in any application for title and/or the assignment, such statements and warranties
as to mortgages, liens and encumbrances upon the above described motor vehicle/boat as they, or either of them, may believe to be true in fact. The
undersigned does hereby ratify and confirm each and every act which said attorneys or either of them may do pursuant to the power herein granted.
the undersigned has executed this instrument on this ________ day of ________________, 20______.
IN WITNESS WHEREOF
Sign Name Here Exactly As It
Sign Other Name Here Exactly As It
Appears On Current Title/Registration
Appears On Current Title/Registration
S
S
IGNATURE
IGNATURE
Print Name Here Exactly As It
Print Other Name Here Exactly As It
P
N
Appears On Current Title/Registration
P
N
Appears On Current Title/Registration
RINTED
AME
RINTED
AME
S
20
WORN TO AND WITNESSED BY ME THIS
DAY OF
N
P
S
OTARY
UBLIC
IGNATURE
M
Y COMMISSION EXPIRES THE
DAY
OF
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