Power Of Attorney Form Page 3
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3Power 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:
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 people named must sign)
Severally (either person named can sign)
G
2—O
.
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
DESCRIBED VEHICLE OR BOAT
Year _____ Make _______________ Model _______________ VIN# _____________________________ Title# _________
DESCRIBED VEHICLE OR BOAT
Year _____ Make _______________ Model _______________ VIN# _____________________________ Title# _________
Disclosure, Signature and Notary Public Section
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
S
S
IGNATURE
IGNATURE
P
N
P
N
RINTED
AME
RINTED
AME
S
20
WORN TO AND WITNESSED BY ME THIS
DAY OF
N
P
S
OTARY
UBLIC
IGNATURE
M
20
Y COMMISSION EXPIRES THE
DAY OF
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