Form T-19A Revised 11-2013
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Affidavit of Authority to Receive Title(s) and/or Title Documents for a Company,
*
Corporation or Partnership
The ______________________________________________________________
(Name of Company, Corporation or Partnership)
_______________________________________________________________________________________
(Street Address)
__________________________________________________________________________________________________
(City, State & Zip)
Hereby certifies that ________________________________________________
(Typed or Printed Full Legal Name of Appointed Attorney-in-Fact)
Has the authority to receive delivery of titles or title documents, on behalf of the
above named company, corporation or partnership.
Sworn to and subscribed before me
This _____ of ______________, 2____
___________________________
(Day)
(Month)
(Year)
(Printed Name)
________________________________________________
_________________________________________
(Notary Public Signature & Notary Seal or Stamp)
(Signature)
________________________________
___________________________
(Date Notary Commission Expires)
(Position or Job Title)
This form must be signed under oath by an officer, partner or owner of
the company, corporation or partnership.
Note: The State Motor Vehicle Division only holds powers of attorney on file
one (1) year from the receipt date in our Customer Service Operations Section.
The above named attorney-in-fact will be required to submit two (2) original
powers of attorney in-person to the Motor Vehicle Division. At that time, one (1)
of the two (2) original powers of attorney will be returned to the submitter with
a stamp affixed indicating that it is on file with the Motor Vehicle Division for one
(1) year from the receipt date. The attorney-in-fact, will then be required to
submit a legible valid copy of this ‘stamped’ power of attorney with each set of
documents where he/she is authorized to pick-up title(s) or title documents on
behalf of your company, corporation or partnership.
*This form can be electronically completed and printed from the Department of Revenue’s web
site, , for signing, notarization and submission in-person only! The address for
the Motor Vehicle Division is: Title Processing Window, Motor Vehicle Division, 4125 Welcome All
Rd, Atlanta, GA 30349. The in-person Customer Service Operations is open Monday through
Friday from 7:30 a.m. to 4:30 p.m. excluding
state
holidays. Except for the signature, this form
must be typed, electronically completed and printed or legibly hand printed in blue or black ink.
An authorized representative of the company, corporation or partnership must sign this
completed form and enter his/her position or job title with the company, corporation or
partnership in the space provided.
Any alteration or correction voids this form.