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Delaware Division of Motor Vehicles Power of Attorney Form


Delaware Division of Motor Vehicles Power of Attorney Form
Delaware Division of Motor Vehicles Power of Attorney Form
TS12(Revised8/28/10)
StateofDelaware
DivisionofMotorVehicles
303TransportationCircle,Room208
Dover,DE19901
(302)7442500
www.deldot.gov/mfta
POWEROFATTORNEY
TaxpayerName
FederalIdentificationNumber
MailingAddress
TelephoneNumber
FAXNumber
City,State,Zip
Individual Partnership Corporation LimitedLiabilityCompany
Other
Thetaxpayernamedaboveappointstheperson(s)namedbelowashis/herattorney(s)infact:
AppointeeName
AppointeeName
AppointeeBusinessName(Ifapplicable)
AppointeeBusinessName(Ifapplicable)
AppointeeAddress(streetandnumber)
AppointeeAddress(streetandnumber)
City
State
Zip
City
State
Zip
TelephoneNumber
Faxnumber
TelephoneNumber
Faxnumber
EmailAddress
EmailAddress
Signature
Signature
Asattorneyinfacttorepresentthetaxpayer(s)forthefollowingtaxorregistrationfeematters:[specify
type(s)oftax]
FuelExciseTaxLaw InternationalRegistrationPlan(IRP)
DyedFuelLaw InternationalFuelTaxAgreement(IFTA)
PublicCarrierLaw UniformCommercialRegistration(UCR)
Over/SizeOverweightLaw HeavyVehicleUseTax(Form2290)
Theattorney(s)infact(oranyofthem)areauthorized,subjecttorevocation,toreceiveconfidentialtax
information and to perform on behalf of the taxpayer(s) the following acts for the tax or fee matters
describedabove:[checkthebox(es)forthepowersgranted]
GeneralAuthorization(includingall actsdescribedbelow).
SpecificAuthorization(selectactsdescribedbelow).
Establishnewaccountsandupdateinformationaccordingly.
Signandfiletaxreturnsforallprogramsindicatedabove.
Registerandrenewvehicles.
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Delaware Division of Motor Vehicles Power of Attorney Form
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