MCS Power of Attorney

In the case of the registrant wanting to appoint another person to act on their behalf when inspecting confidential  IRP/IFTA related to that person, the following form has to be completed and submitted in order to grant the assigned person the legal power to do so.

Extracted Text for Proper Search

HSMV 96440 (06/11) 
 Division of Motorist Services 	
Bureau of Commercial Vehicles and 	
Driver Services 	
POWER OF ATTORNEY 	
and Declaration of Representative 	
 
A photocopy of the Registrant’s Driver License must be submitted with this Power of Attorney. 	
PART 1 – POWER OF ATTORNEY 
 
Section 1. Registrant/Licensee Information.	  Registrant/Licensee must sign and date this form in section 1 and section 6.  (See 
Page 2 Section 6) 	
Registrant/Licensee Name and Address as shown on Cab Card or 
IFTA License: 
________________________________________ 
________________________________________ 
________________________________________ 
Signature of Applicant: __________________________________ 
Print Name:	
_______________________________ 	 	
Federal ID No.(s)  
(SSN, FEIN, etc): 
 
 
________________ 
 
________________ 
 	
Registrant Telephone Number:   
______________________  
Fax Number:  
______________________  	
Hereby appoints the following representative as attorney-in-fact: 
 
Section 2	.  Representative.  Representative must sign and date this form.  (See Page 2 Part II) 	
Name and Address of person or company being appointed as Power of Attorney.  
(Include name of firm if applicable): 
 
___________________________________________________ 
___________________________________________________ 
___________________________________________________ 
*
If appointed representative is a company a separate letter must be attached 
indicating those employees authorized to sign on behalf of the company.  
Letter must include signature of all authorized signers.*	
 	
Telephone Number: 
Fax Number: 
Email Address: 
Telephone Number: 
Fax Number: 
Email Address: 	
To represent the Registrant/Licensee before the Florida Department of Highway Safety and Motor Vehicles related to the 
following International Registration Plan (IRP) and/or International Fuel Tax Agreement (IFTA) accounts. 
 
Section 3.	  Accounts 	
Account Numbers  Account Name 
IRP Acct. No. / Fleet No.(s):   
IFTA Acct. No.:   
 
Section 4.  Acts Authorized 
The representative(s) are authorized to receive and inspect confidential IRP/IFTA information and to perform any and all 
acts that I (we) can perform with respect to the accounts described in Section 3.  Except as otherwise provided, the 
authority specifically includes the power to:  file IRP and IFTA applications; receive IRP and IFTA credentials; file IFTA 
tax returns, including claims for refunds; represent the Registrant/Licensee in audit and/or collection matters; and execute 
consents for compromise and closing agreements.  The authority does not include the power to endorse or cash warrants. 
 
List any specific limitations or deletions to the acts otherwise authorized in the Power of Attorney.	 
_________________________________________________________________________________________ 
_________________________________________________________________________________________ 	
Section 5.  Retention/Nonrevocation of Prior Power(s) of Attorney 
The filing of this Power of Attorney will not revoke earlier Power(s) of Attorney on file with the Florida Department of 
Highway Safety and Motor Vehicles even for the same matters covered by this document. 
If you want to revoke a prior Power of Attorney, check this box................................................................................... 
You must attach a copy of any Power of Attorney you wish to revoke. 	
DMS USE ONLY