Form T-19A Revised 05-2006
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.
Any alteration or correction voids this form.
Print this form!
Clear form
1
