Fillable Authorization Letter printable pdf download

OHIO DEPARTMENT OF PUBLIC SAFETY

BUREAU OF MOTOR VEHICLES

REGISTRATION INFORMATION and AUTHORIZATION to REGISTER

TO BE COMPLETED BY THE OWNER OR PURCHASER OF VEHICLE(S) LISTED BELOW

I, _____________________________________________ of __________________________________________________________________hereby

Print Full Name of Vehicle Owner

Print Address of Vehicle Owner

appoint ________________________________________________ of ________________________________________________________________

Print Full Name of Person Granted Authority

Print Address of Person Granted Authority

to make application, in my stead, for registration or transfer of registration for the following vehicle(s):

PLATE NUMBER

VEH. YEAR

MAKE

TYPE

COLOR

SERIAL NUMBER

VEHICLE OWNER DATE

VEHICLE OWNER OH DL#/OH ID#

VEHICLE OWNER SSN (IF NO OH

VEHICLE OWNER EIN/TIN

OF BIRTH

DL/OH ID)

FOR BMV USE ONLY/CLERK VERIFICATION OF VEHICLE OWNER

LIST DOCUMENT W/ SSN VEHICLE OWNER PRESENTED

OH DL/OH ID/MATCH

IF NO OH DL/OH ID, PROOF OF SSN REQUIRED

IN THE CASE OF A LEASE OR JOINT OWNERSHIP, YOU WILL BE REQUIRED TO PROVIDE THE LESSEE/ADDITIONAL OWNER’S OHIO

DRIVER LICENSE NUMBER (DL), OHIO ID CARD NUMBER (ID), SOCIAL SECURITY NUMBER (SSN), TAX IDENTIFICATION NUMBER (EIN/TIN).

LESSEE/ADDITIONAL VEHICLE OWNER NAME

LESSEE/ADDITIONAL VEHICLE OWNER OH DL#/OH ID#

LESSEE/ADDITIONAL VEHICLE OWNER SSN (IF NO OH DL/OH ID)

LESSEE/ADDITIONAL VEHICLE OWNER EIN/TIN

FOR BMV USE ONLY/CLERK VERIFICATION OF LESSEE

LIST DOCUMENT W/ SSN LESSEE PRESENTED

OH DL/OH ID/MATCH

IF NO OH DL/OH ID, PROOF OF SSN REQUIRED

IDENTIFICATION OF PERSON GRANTED AUTHORITY (PGA)

PGA U.S./CANADIAN DL#/ID#

PGA SSN (IF NO U.S./CANADIAN DL/ID IS AVAILABLE)

FOR BMV USE ONLY/CLERK VERIFICATION OF PERSON GRANTED AUTHORITY

CLERK’S INITIALS

U.S./CANADIAN DL/ID (PGA can present U.S. or Canadian DL/ID)

I certify I have reviewed documents to verify DL/ID or SSN.

SSN VIA ACCEPTABLE DOCUMENT

I acknowledge that I (we), the owner(s), or lessees of leased vehicle now have insurance or other financial responsibility coverage covering this vehicle

and I (we) will not operate or permit the operation of this vehicle without FR coverage, and that the vehicle will not be used as a commercial vehicle

unless so registered. I understand and acknowledge that making false statements on this document is illegal and may subject me to criminal penalties.

SIGNATURE OF OWNER(S)

DATE

COUNTY OF RESIDENCE

CITY OR TOWNSHIP OF RESIDENCE

FOR LIST OF ACCEPTABLE DOCUMENTS, GO TO

ACCEPTABLE DOCUMENTS LIST: FORM BMV 2424

YOU WILL LOSE YOUR DRIVER LICENSE IF YOU DRIVE WITHOUT INSURANCE OR OTHER ACCEPTABLE FINANCIAL RESPONSIBILITY COVERAGE

• In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage.

• It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage.

• PROOF OF COVERAGE IS REQUIRED:



Whenever a police officer issues a traffic ticket

At all vehicle inspection stops

Upon traffic court appearances and

Upon random checks by the

Registrar of Motor Vehicles.

• ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL:



Lose his or her driver license until requirements are met on first offense, ONE YEAR

on second offense and TWO YEARS on additional offenses



Lose his or her license plates and vehicle registration



Pay reinstatement fees of $100.00 for first offense, $300.00 for second offense,



and $600.00 for third and subsequent offenses

Pay a $50.00 penalty for any failure to surrender his or her driver license, license plates, or registration AND

Be required to maintain special FR

coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for THREE or FIVE YEARS.

• ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated for at least 30 DAYS first

offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be permitted to register any motor vehicle in Ohio for FIVE YEARS.

• IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have



A SECURITY SUSPENSION for TWO

YEARS or more and



A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied).

• THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW.

• WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE.







DETACH BOTTOM PORTION FOR YOUR RECORDS

THIS COMPLETED FORM MUST BE ATTACHED TO THE BMV APPLICATION

•

In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage.

•

It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage.

•

PROOF OF COVERAGE IS REQUIRED: • Whenever a police officer issues a traffic ticket • At all vehicle inspection stops • Upon traffic court appearances and • Upon random checks by the Registrar

of Motor Vehicles.

•

ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL: • Lose his or her driver license until requirements are met on first offense, ONE YEAR on

second offense and TWO YEARS on additional offenses • Lose his or her license plates and vehicle registration • Pay reinstatement fees of $100.00 for first offense, $300.00 for second offense, and

$600.00 for third and subsequent offenses • Pay a $50.00 penalty for any failure to surrender his or her driver license, license plates, or registration AND • Be required to maintain special FR

coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for THREE or FIVE YEARS.

•

ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated for at least 30 DAYS first

offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be permitted to register any motor vehicle in Ohio for FIVE YEARS.

•

IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have • A SECURITY SUSPENSION for TWO

YEARS or more and • A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied).

•

THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW.

•

WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE.

•

WHEN REQUIRED, PROOF OF COVERAGE MAY BE SHOWN BY ANY OF THE FOLLOWING: • AN INSURANCE POLICY showing automobile liability insurance of at least $12,500 bodily injury per

person, $25,000 injury two or more persons, and $7,500 property damage • AN INSURANCE IDENTIFICATION CARD (same coverage) • A SURETY BOND OF $30,000 issued by any authorized

surety company or insurance company • A BMV BOND SECURED BY REAL ESTATE having equity of at least $60,000 • A BMV CERTIFICATE FOR MONEY OR GOVERNMENT BONDS in the

amount of $30,000 on deposit with the Ohio Treasurer of State • A BMV CERTIFICATE OF SELF-INSURANCE, available only to companies or persons who own at least twenty-six motor vehicles.

RESTRICTED

BMV 5736 9/12 [760-1058]

Authorization Letter

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