Form T-19c - Affidavit Of Authority To Sign For A Company, Corporation Or Partnership

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For County Use Only!
Form T-19C (County Use) 05-2006
Affidavit of Authority to Sign for a Company, Corporation or Partnership*
Any alteration or correction voids this form.
Date: ________________________________
We, ________________________________________________________________________________
(Name of Company, Corporation or Partnership)
_________________________________________________________________________________________________________
(Street Address)
____________________________________________________________________________________
(City, State & Zip)
certify that___________________________________________________________________________
(Typed/Printed Name of Individual Granted Authority to Sign for Your Company, Corporation or Partnership)
has the authority to execute title/tag documents on behalf of our company, corporation or partnership
for vehicles owned by our company, corporation, or partnership.
Note: An officer, partner or owner of the company, corporation or partnership must sign
this form under oath.
Sworn to and subscribed before me:
, _________________________
_________________________________
This day of
(Day)
(Month)
(Year)
(Printed Name of Officer, Partner or Owner)
_______________________________________________
_____________________________________________
(Printed/Typed Name of Notary Public)
(Signature of Officer, Partner or Owner)
____ _____________________________ _____________
_____________________________________________
(Notary Public’s Signature & Notary Seal or Stamp)
(Job Title/Position)
_______________________________________________
(Date My Notary Commission Expires)
General Information
The _________________________ tag office retains these affidavits, Form T-19C, in their office for
(County Tag Office Name)
one (1) year from the date received. The individual granted authority to sign for a company,
corporation or partnership must submit two (2) original affidavits, Form T-19C. The county tag office
will return to the individual one (1) original, stamped affidavit, which indicates that it is in the county’s
This form cannot be submitted to the
files and is valid for one (1) year from the date received.
state office or another county tag office, once stamped and approved. It must be
submitted to the county tag office that has the ‘original’ form on file.
The authorized
individual must submit a legible copy of the ‘stamped’ affidavit, Form T-19C, with each set of title/tag
documents submitted for processing 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. 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.
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