Florida Power of Attorney for a Motor Vehicle, Mobile Home or Vessel

In the case of wanting to allow another person to act on your behalf on a motor vehicle that you own, the following form has to be completed and submitted.

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STATE OF FLORIDA	 	 	DDEEPPAARRTTMMEENNTT  OOFF  HHIIGGHHWWAAYY  SSAAFFEETTYY  AANNDD  MMOOTTOORR  VVEEHHIICCLLEESS  ––  DDIIVVIISSIIOONN  OOFF  MMOOTTOORRIISSTT  SSEERRVVIICCEESS  	  	SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE	 	wwwwww..ffllhhssmmvv..ggoovv//ooffffiicceess//  	 	
POWER OF ATTORNEY FOR A MOTOR 	VEHICLE, MOBILE HOME OR VESSEL	 	
 	
______________________________________________________  	                                            ((DDaattee))  	
 	
I/We	 hereby name and appoint, __________________________________________________________, to be my	/our 	 	
 	(Full 	Legibly Printed	 Name is Required)	 	 lawful 	attorney	-in-fact, to act for me	/us	, in applying for an original or duplicate certificate of title, to register, transfer title, 	
or 	record a lien	 to the motor vehicle, mobile home or vessel described below, and to print my	/our	 name and sign their 	
name, in m	y/our	 behalf.  My attorney	-in-fact can also do all things necessary to the application or any other related 	
instrument and to bind me	/us	 in as sufficient a manner as I	/we	 myself	/ourselves	 could do, were I	/we	 personally present 	
and signing the same.	 	 With 	full power of substitution and revocation, I	/we	 hereby ratify and confirm whatever my	/our	 said attorney	-in-fact may 	
lawfully do or cause to be done in the virtue hereof.	 	 	
CHECK ONE:	 	 Motor Vehicle 	 	 Mobile Home	 	 Vessel	 	 	
Year	   	
Make/Manufacturer	 	Body Type	 	Title Number	 	
                        	Vehicle/Vessel Identification Number	 	
 	 	
NOTICE TO OWNER	(S)	:  COMPLETE THIS FORM IN ITS ENTIRETY PRIOR TO SIGNING.	 	 	
UNDER PENALTIES OF P	ERJURY, I	/WE	 DECLARE THAT I	/WE	 HAVE READ THE FOREGO	ING DOCUMENT AND 	
THAT THE FACTS STATE	D IN IT ARE TRUE.	 	
 
_______________	_____	_____________________________     	     	_________________________________________	_________	 	  	(Signature of 	Owner	 "Grantor	”) 	 	              	                       	         	(Legibly Printed Name 	of Owner 	"Grantor")	 	
 	______________________________________________________________________________	__________________________	 	    (Driver License, Identification Card	 or FEID Number	 for 	Owner	) 	 	 	(Date 	of Birth	 for 	Owner	, if applicable)	 	
 	_____________________________________________________________________________	__________________________	_ 	    (Owner’s 	Address )	 	(City)	 	State)	 	    (Zip)	 	
 	_______________	__________________________________          	_________________________________________	_________	 	  	(Signature of 	Co-Owner	 "Grantor	,” if applicable	) 	                                  	(Legibly Printed Name of Co	-Owner 	"Grantor	," if applicable	) 	
 	______________________________________________________________________________	__________________________	 	    (Driver License, Identification Card	 or FEID Number	 for 	Co-Owner	)  	 	(Date of Birth	 for 	Co-Owner	, if applicable)	 	
 	_____________________________________________________________________________	__________________________	_ 	    (Co-Owner’	s Address	) 	(City)	 	(State)	 	    (Zip)	 	
  This non	-secure power of attorney form may be used when an individual or entity appointed as the 	attorney	-in-fact will 	be completing the odometer disclosure statement as the 	buyer only	 or the 	seller only.  	However, this form cannot be 	used to allow an individual or entity (such as a dealership) to sign as both buyer 	and	 seller for the purpose of discl	osing 	the odometer reading.  This may be accomplished only with the secure power of attorney (HSMV 82995) when:	 	 (a)	 	the title is physically being held by the lienholder; 	or 	 	(b)	 	the title is lost	. 	 NOTE: 	 A licensed dealer and his	/her	 employees are considered a single entity.	 	 
Check your local phone book government pages or visit the following website for current mailing addresses	: 	
http://www.flhsmv.gov/offices/	 	 HSMV 82053 (Rev. 	12/11) S	 	 	www.flhsmv.gov