Power Of Attorney Al Mvd

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A
D
R
MVT 5-13
LABAMA
EPARTMENT OF
EVENUE
1/13
M
V
D
OTOR
EHICLE
IVISION
THIS FORM MAY
BE REPRODUCED
Power of Attorney
VEHICLE IDENTIFICATION NUMBER (VIN)
*
YEAR
MAKE
MODEL
BODY TYPE
LICENSE PLATE NUMBER
STATE OF ISSUANCE
Taxpayer Information
Representative(s): Hereby appoint(s) the following representative(s)
Taxpayer Name(s) and Address (Please Type or Print)
Name and Address (Please Type or Print)
Email Address**___________________________________________________
Telephone Number** (_______)___________________
Fax Number**
(_______)___________________
As my attorney-in-fact to sign my name and do all things necessary for the purpose(s) of:
Title application, transfer or lien filing
IFTA transaction(s)
register and purchase license plate(s),
other purpose, describe _________________________________________________________________________________________,
for my motor vehicle described above.
ACTS AUTHORIZED
The representative(s) is authorized to receive and inspect confidential tax information and to perform any and all acts that I (we) can perform
with respect to the matters described above. The authority does not include the power to receive refund checks or the power to sign certain
returns.
LIST ANY SPECIFIC ADDITIONS OR RESTRICTIONS TO THE ACTS OTHERWISE AUTHORIZED IN THIS POWER OF ATTORNEY:
Sworn to and subscribed before me on date above stated.
_______________________________________________
SIGNATURE OF TAXPAYER
DATE
_______________________________________________
NOTARY PUBLIC
My commission expires:
_______________________________________________
_______________________________________________
SIGNATURE OF TAXPAYER
DATE
_________________________________________________________ ____________________
Signature of Appointee:
NOT VALID WITHOUT THIS SIGNATURE
DATE
If a business firm or corporation is appointed, the signature shall be of an authorized representative of the firm who will perform as attorney-
in-fact for the owner.
SPECIAL NOTICE: Any alterations or strikeovers shall void this Power of Attorney. Original signatures are required.
*All VINs for 1981 and subsequent year model vehicles that conform to federal anti-theft standards are required to have 17 digits/characters.
** Optional

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