Power of Attorney – Motor Vehicle Only

____________________, the “Principal,” of ______________________, hereby appoints _____________________, of ______________________, as their Attorney-in-Fact to act in their place and stead, with full authority to perform all necessary acts to transfer title and ownership of the following motor vehicle:

• Make: ___________
• Model: ______________
• Year: ___________
• Body Type: ____________
• Vehicle Identification Number (VIN): ________________________

This authority includes, but is not limited to, signing any documents required by the Department of Motor Vehicles or any other entity in connection with the transfer of said vehicle.

Odometer Disclosure Statement

IMPORTANT: Federal law requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment.

Current odometer reading: ______________ miles

Certify one of the following (mark with “XXX”):

___ I (we) certify that to the best of my (our) knowledge, the odometer reading reflects the actual mileage of the vehicle described above.

___ I (we) certify that to the best of my (our) knowledge, the odometer reading reflects mileage in excess of the designed mechanical limits (i.e., over 99,999 miles).

___ I (we) certify that to the best of my (our) knowledge, the odometer reading does not reflect the actual mileage of the vehicle described above and should not be relied upon.

Odometer Alteration Statement

Certify one of the following (mark with “XXX”):

___ I (we) certify that the odometer was not altered, set back, or disconnected while in my (our) possession, nor am I (are we) aware of anyone else doing so.

___ I (we) certify that the odometer was altered for repair or replacement purposes during my (our) ownership, and the mileage after service matches that before repair.

___ I (we) certify that the odometer was repaired or replaced and reset to zero because it could not register the original mileage. The mileage on the original or prior odometer was: __________________ miles.

Sales Price

The agreed-upon sales price of the above-described vehicle is:
$ ______ (________________________ & ____/100 dollars)

_________________________________________
Signature of Authorizer of Power of Attorney

Acknowledgment

STATE OF __________________
COUNTY OF __________________

On this day, ____________________ personally appeared before me and acknowledged the execution of this Power of Attorney for the purposes stated herein.

Dated: ____________________________

_________________________________________
Notary Public

My Commission Expires: ____________________________

Review List

This Review List is provided to help guide the proper use and storage of this document:

• This is a limited purpose Power of Attorney applicable only for the sale or transfer of a motor vehicle.
• You may adapt this form for other limited-purpose transactions as needed.
• Make multiple copies of this completed and notarized document.
• Store copies with your vehicle, insurance documents, and related records.
• In certain states, proof of vehicle sale and transfer is necessary to cancel insurance coverage or avoid ongoing liability.