Corpcode Request To The New Jersey Motor Vehicle Commission Form
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1Suggested Format for Power of Attorney
Please cut and paste onto your official company letterhead and submit with
Corpcode Request to the New Jersey Motor Vehicle Commission
Name of Company: ______________________________________________________
Mailing Address:
_______________________________________________________
City:__________________________________State: ______ Zip: _________________
Street Address if mailing address is a PO Box: ________________________________
Federal Taxpayer ID#:_______________________ Phone #:______________________
Business Description:_____________________________________________________
Power of Attorney is being authorized for the following motor vehicle business:
[ ] Request corpcode
[ ] Title vehicle
[ ] Register vehicle
: __________________________________________
Power of Attorney being granted to
(Please print name)
__________________________________________
Relationship to Company:
(Must be employed by or hired by your company)
If you plan on titling and or registering vehicle, please provide the following:
(may copy this section multiple times for multiple vehicles)
Vehicle type:_____________ Make:___________________ Model:_________________
Year of vehicle:_______________ VIN or Hull#: ________________________________
Insurance Co. Name:_________________________Policy #: _____________________
Phone #: _____________________
I hereby certify to the accuracy of the above information and that the person to whom
Power of Attorney is being granted and I are both legally residing in the United States.
Print Name and Title of Company Official authorizing Power of Attorney:
_____________________________________ _________________________________
(Name)
(Title)
STOP: SIGN IN THE PRESENCE OF A NOTARY
:________________________________
___________
Company Official’s Signature
Date:
(Must be same person as stated directly above)
________________________
__________________
Driver License #:
State of Issuance:
Note: A photocopy of the driver license of the company official granting the Power of Attorney and a
photocopy of the individual given the Power of Attorney must be attached to this document.
This space is reserved for Notary Only:
8/04
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