Form Vsa 70 - Dmv Power Of Attorney To Sign For Owner

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POWER OF ATTORNEY TO SIGN FOR OWNER
VSA 70 (12/01/2010)
WHEN REGISTERING AND/OR TRANSFERRING OWNERSHIP OF A MOTOR VEHICLE
VEHICLE OWNER(S):
OWNER NAME (last, first, middle)
CO-OWNER NAME (last, first, middle)
OWNER STREET ADDRESS
CO-OWNER STREET ADDRESS
CITY
STATE
ZIP
CITY
STATE
ZIP
POWER OF ATTORNEY GRANTED TO:
FULL LEGAL NAME (last)
(first)
(middle)
(suffix)
STREET ADDRESS
CITY
STATE
ZIP
VEHICLE INFORMATION
VEHICLE MAKE
BODY TYPE
MODEL YEAR
VEHICLE IDENTIFICATION NUMBER (VIN)
TITLE NUMBER
CERTIFICATION
I/We, being the owner(s) of the motor vehicle described above, by these presents do make, constitute, and appoint the person named above true and lawful
attorney-in-fact to sign in my/our name, place, and stead any Certificate of Title, or other supporting papers, covering said motor vehicle, in whatever manner
necessary to register and/or transfer ownership of said motor vehicle; and I/we do hereby grant unto said attorney-in fact full authority and power to do and
perform any and all other acts necessary or incidents to the execution of the powers herein expressly granted, as the grantor might or could do if personally
present, with full power of substitution.
I/We further certify and affirm that all information presented in this form is true and correct, that any documents I/we have presented to DMV are genuine, and
that the information included in all supporting documentation is true and accurate. I/We make this certification and affirmation under penalty of perjury and I/we
understand that knowingly making a false statement or representation on this form is a criminal violation.
OWNER SIGNATURE
CO-OWNER SIGNATURE
DATE
DATE
OWNER SOCIAL SECURITY NUMBER/EMPLOYER FEDERAL ID
CO-OWNER SOCIAL SECURITY NUMBER/EMPLOYER FEDERAL
NUMBER (If vehicle owned by a company or corporation)
(mm/dd/yyyy)
ID NUMBER (If vehicle owned by a company or corporation)
(mm/dd/yyyy)

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