Form 4054 - Power Of Attorney
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1MISSOURI DEPARTMENT OF REVENUE
4054
FORM
MOTOR VEHICLE BUREAU
POWER OF ATTORNEY
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(REV. 1-2009)
I (WE) HEREBY APPOINT ___________________________________________________________________________ AS MY (OUR) ATTORNEY-IN-FACT FOR THE
PURPOSE OF TRANSFERRING OR MAKING APPLICATION FOR TITLE AND REGISTRATION TO THE FOLLOWING DESCRIBED UNIT:
YEAR
MAKE
IDENTIFICATION NUMBER
___ ___ ___ ___
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
WITH THE FULL AUTHORITY TO SIGN ON MY (OUR) BEHALF ALL PAPERS AND DOCUMENTS AND TO DO ALL THAT IS NECESSARY TO THIS APPOINTMENT.
OWNER’S PRINTED NAME
OWNER’S PRINTED NAME
OWNER’S SIGNATURE
OWNER’S SIGNATURE
NOTARY INFORMATION
NOTARY PUBLIC EMBOSSER SEAL
STATE OF
COUNTY (OR CITY OF ST. LOUIS)
SUBSCRIBED AND SWORN BEFORE ME, THIS
USE RUBBER STAMP IN CLEAR AREA BELOW.
DAY OF
NOTARY PUBLIC SIGNATURE
MY COMMISSION
EXPIRES
NOTARY PUBLIC NAME (TYPED OR PRINTED)
MO 860-1005 (1-2009)
MISSOURI DEPARTMENT OF REVENUE
4054
FORM
MOTOR VEHICLE BUREAU
POWER OF ATTORNEY
(REV. 1-2009)
I (WE) HEREBY APPOINT ___________________________________________________________________________ AS MY (OUR) ATTORNEY-IN-FACT FOR THE
PURPOSE OF TRANSFERRING OR MAKING APPLICATION FOR TITLE AND REGISTRATION TO THE FOLLOWING DESCRIBED UNIT:
YEAR
MAKE
IDENTIFICATION NUMBER
___ ___ ___ ___
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
WITH THE FULL AUTHORITY TO SIGN ON MY (OUR) BEHALF ALL PAPERS AND DOCUMENTS AND TO DO ALL THAT IS NECESSARY TO THIS APPOINTMENT.
OWNER’S PRINTED NAME
OWNER’S PRINTED NAME
OWNER’S SIGNATURE
OWNER’S SIGNATURE
NOTARY INFORMATION
NOTARY PUBLIC EMBOSSER SEAL
STATE OF
COUNTY (OR CITY OF ST. LOUIS)
SUBSCRIBED AND SWORN BEFORE ME, THIS
USE RUBBER STAMP IN CLEAR AREA BELOW.
DAY OF
NOTARY PUBLIC SIGNATURE
MY COMMISSION
EXPIRES
NOTARY PUBLIC NAME (TYPED OR PRINTED)
MO 860-1005 (1-2009)
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