Montana Mvd Power Of Attorney
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1Power
of
Attorney
Title and Registration Bureau
1003 Buckskin Drive, Deer Lodge, MT 59722-2375
Phone (406) 846-6000 Fax (406) 846-6039
mvdtitleinfo@mt.gov
The power of attorney must be exercised by the person or company named on this form, and is only valid on the title
or on the document for which the authority is granted.
If an individual holds the power of attorney, that person must write the name of the owner, followed by his/her
signature and "POA." Example: Sharon Smith by Jane Doe POA (Sharon Smith is the owner and Jane Doe is the
person named as representative on the power of attorney).
If a business holds the power of attorney, the representative of that business must write the name of the owner
followed by the name of the business, and then his/her signature and "POA." Example: Sharon Smith by Morrison's
Garage George Morrison POA.
The Vehicle Owner/Applicant Must Complete This Section
I (print your legal name)
Address, City, State and Zip Code
Appoint (print the name of the business or individual)
Address
City
State
Zip Code
my attorney in fact with full authority to execute any and all instruments, documents, affidavits, etc. to effect
registration, transfer of title, application for title, or _______________________________________________ in my
place and stead on the following motor vehicle/vessel:
Title Number
Year
Make
Model
Vehicle Identification Number
Color
License Plate Number
I state that the (check one)
five- or
six-digit odometer now reads (no tenths) _________________ miles, date
read ______________ and, to the best of my knowledge, it reflects the actual mileage unless one of the following
statements is checked:
The odometer reading reflects the amount of mileage in excess of its mechanical limits.
DO NOT CHECK
UNLESS APPLICABLE
The odometer reading is not the actual mileage. Warning – odometer discrepancy.
Owner/Applicant Signature: __________________________________________________ Date: _______________
The Vehicle Purchaser (if applicable) Must Complete This Section
I certify that the odometer reading made above by the vehicle owner/applicant is correct.
___________________________________________________
_____________________________________
Purchaser's signature - this is my legal signature (only one signature is required)
Purchaser's printed name
______________
___________________________________________________________________________
If applicant is a firm or corporation, print full name
Date
A Notary Public Must Complete This Section
________________________________________________
_______________
Owner/Applicant Signature:
Date:
DO NOT NOTARIZE OR VERIFY UNLESS SIGNED IN YOUR PRESENCE AND PRINTED NAME OF OWNER/APPLICANT IS LISTED.
_________________________
______________
State of
Subscribed and affirmed to before me on (date)
by (clearly print
________________________
______________________________
County of
name of person appearing before you)
___________________________________________
Notary Signature
_____________________________________________
(seal)
Printed Name
______________________________________________
Title or Rank
______________________
_______________
For the State of
County of
_______________________________________________
Residing at
_______________________________________
My Commission Expires
Montana county and state authorities reserve the right to reject any form that has been altered
MV65 (07/06)
This form is available in alternate formats for people with disabilities
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