Form Tr-128 - Appointment Of Agent For A Vehicle, Watercraft, Or Mobile Home
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Michigan Department of State
APPOINTMENT OF AGENT
For a Vehicle, Watercraft, or Mobile Home
NOTE: This form CANNOT be used to apply for an instant title, unless the Agent is
a licensed vehicle dealer.
All Information must be completed in ink.
I appoint ___________________________________________________
(agent’s name)
Agent’s address: ____________________________________________
____________________________________________
Agent’s Driver License
______________________________________
Number or ID Card Number:
as my agent to sign my name to legal documents pertaining to the sale, purchase or
titling of the unit described below which is required to be titled under Michigan law.
Year
VIN
Make
License Plate Number (if any)
Vehicle, Watercraft, or Mobile Home Owner Information
Owner’s Name
Owner’s Street Address
City
State
Zip Code
Daytime Phone Number
(
)
Owner’s Driver License or ID Card Number
Today’s Date
A false statement in connection with a title transaction is a crime.
NOTE: Owner must provide a photocopy of their valid driver
license or state ID card to the agent listed above.
X
Owner’s Signature:
Authorities granted under Public Acts 300 of 1949, 451 of 1994, and 96 of 1987, as amended.
TR-128 (06/15)
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Parent category: Business