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Colorado Power of Attorney for Motor Vehicle Only Form


Colorado Power of Attorney for Motor Vehicle Only Form
Colorado Power of Attorney for Motor Vehicle Only Form
State of Colorado
Power of Attorney for Motor Vehicle Only
C.R.S. 15-14-701 and C.R.S 15-14-705
DR 2175 (08/21/12)
COLORADO DEPARTMENT OF REVENUE
Division of Motor Vehicles
Title and Registration Sections
www.colorado.gov/revenue
ANY ALTERATION OR ERASURE MAY VOID THIS DOCUMENT
The purpose of this Power of Attorney is to give the person you designate (your agent) powers to handle your property and affairs, which may
include power to pledge, sell, or otherwise dispose of the motor vehicle described below without any advance notice to you. This form does
not impose a duty on your agent to exercise granted powers, but your agent must use due care to act on your benet and in accordance with
the provisions of this form and must keep a record of receipts, disbursements, and signicant actions taken as agent.
I (Grantor - insert your full name or name of entity if applicable as it appears on identication) ____________________________________
_______________________________________________________________________________________________________________________
Appoint (insert full name or name of entity if applicable as it appears on identication) __________________________________________
_______________________________________________________________________________________________________________________
as my agent to act for me in any lawful way with respect to the following powers as marked pertaining to only the Motor Vehicle
described below: (PLEASE CHECK ALL APPLICABLE POWERS. YOU MAY CROSS OUT ALL POWERS WITHHELD.)
__ Apply for and Receive a New Registration or New Temporary Registration.*
__ Apply for and Receive Certicate of Title.*
__ Apply for and Receive Duplicate Certicate of Title
(Secure and Veriable Identication is required only when the original title was issued on or after July 1, 2006)*
__ To transfer ownership and acknowledge odometer reading
__ To record a lien
__ To release a lien
__ To apply for and receive a copy of a motor vehicle record
__ To receive a Persons with Disability Parking Privileges placard
TERMINATION DATE REQUIRED: This Power of Attorney terminates on ____/____/____. The original Power of Attorney must be
surrendered to transfer ownership and acknowledge the odometer reading. Certied copies are acceptable for all other powers. A copy
may be retained by the agent for record keeping purposes.
*(Notice to Grantor: Secure and veriable identication is required to obtain a title or registration in the State of Colorado)
Vehicle Identication Number(VIN) Year Make Model
If a power of attorney is used and the individual appointed as the agent will be completing the odometer disclosure statement as the buyer
only or the seller only, this non-secured form may be used. THIS FORM CANNOT BE USED to allow an individual or entity to sign as both
buyer and seller disclosing and acknowledging the odometer reading. This may be accomplished only with the DR 2174, Secure Power
of Attorney form.
NOTICE TO AGENTS: BY EXERCISING POWERS UNDER THIS DOCUMENT, THE AGENT ASSUMES THE FIDUCIARY AND
OTHER LEGAL RESPONSIBILITIES OF AN AGENT UNDER COLORADO LAW.
I agree that any third party who receives a copy of this document may act under it unless a transfer of ownership is occurring.
All transfers of ownership require the original of this document.
I agree to indemnify the third party for any claims that arise against the third party because of reliance on this Power of
Attorney.
I certify, under penalty of perjury in the second degree, that the above information is true and accurate to the best of my
knowledge.
Printed Name as it Appears on Identication of Owner/Co-Owner (Grantor)
Signature of Owner/Co-Owner (Grantor) Date
Identication of Owner/Co-Owner (Grantor):
Colorado DL Colorado ID Other ______________________________________________________________
ID # Expires DOB
Subscribed and afrmed, or sworn to before me, in the State of __________________________________ , County
of
____________________________ , this _____________________day of ________________ , 20 _______ , by
________________________________________________________ (Grantor), who executed this form in my presence and presented
the identication described above.
_________________________________________
Notary Public Signature
_________________________________________
Notary Public Printed Name
My Commission Expires _____________________
Notary Seal
Colorado Power of Attorney for Motor Vehicle Only Form