Form Pan-82 - Power Of Attorney - Pennsylvania (2011) Page 2
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2AGENT ACKNOWLEDGMENT
I,________________________________________ have read the attached power of attorney and am the person
identified as the agent for the principal. I hereby acknowledge that in the absence of a specific provision to the
contrary in the power of attorney or in 20 Pa.C.S. when I act as agent:
I shall exercise the powers for the benefit of the principal.
I shall keep the assets of the principal separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal.
Agent
Date
PAN - 82b (8/11)
PENNSYLVANIA ASSOCIATION OF NOTARIES
One Gateway Center, Suite 401 ▪ 420 Fort Duquesne Boulevard ▪ Phone: 800-944-8790 ▪ Fax: 800-707-7075 ▪ ▪
Commonwealth of Pennsylvania
)
POWER OF ATTORNEY
) SS:
County of _______________________
)
Before me, the undersigned notary public, this day personally appeared _______________________________________
____________________________________ to me known, who being duly sworn, did make, constitute and appoint
___________________________________ is (his) (her) (their) true and lawful attorney, and authorized said attorney to
sign for the affiant(s) any application for assignment of or transfer of title, or application for a transfer of registration, or
any other form involving title or registration for the vehicle described below:
Subscribed and sworn to before me this _________ day of
Make __________________________Year_________
___________________ , 20 ____
VIN # _______________________________________
Notary Public
(Affiant sign here.)
EMBOSSING SEAL:
RUBBER STAMP SEAL:
(Co-owner, if any, sign here.)
PAN - 82c (8/11)
PENNSYLVANIA ASSOCIATION OF NOTARIES
One Gateway Center, Suite 401 ▪ 420 Fort Duquesne Boulevard ▪ Phone: 800-944-8790 ▪ Fax: 800-707-7075 ▪ ▪
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