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INSTRUCTIONS
Revised 8/2013
WHO MUST FILE. Anylicenseewho wishes to secure
representation by another party in matters before the
Nebraska Department of Motor Vehicles (NEDMV) with
regard to any fuel tax reported as a part of the IFTA,
certificates of title, registration feesand sales taxas a
part of the IRP, or fees paid related to UCRor audit of
any of the above, must file a Power of Attorney (POA)
authorizing that party to receive confidentialinformation
regarding said licensee. This form is provided for the
licensee’sconvenience in designating a POA, but it is not
the sole form which may be used. The NEDMV will honor
all other properly completed and signedPOA
designations.
WHEN AND WHERE TO FILE. The completed POA may be
filed any time but this form or some other properly
completed and signed POA must be filed with the
NEDMV before the person designated can represent the
licenseein matters involving disclosure of confidential
tax, registration or other fee information under the
administration of the NEDMV.
This form, or other appropriate POA, may be scanned
and emailed, faxed or mailed to the NEDMV:
•Email to
mcs.web@nebraska.gov
•Fax to 402-471-4024or 402-471-3920
•Mail to the NEDMV - Motor Carrier Services,
PO Box 94729, Lincoln, NE 68509-4729
LICENSEE’S NAME AND ADDRESS. If the licenseehas a
DBAname, list both the legal name and DBAname and
include the licensee’saccountnumber assigned by the
NEDMV.
DESIGNATION OF ATTORNEY-IN-FACT. An attorney-in-
fact is any person who is acting on behalf of another.
Enter the appropriate information pertaining to each
person to whom representative authority and power is
being delegated. Space is provided for listing two
appointees. If additional space is required, attach a
separate statement clearly showing the names,
addresses, zip codes, and telephone numbers of the
additional appointees.
MOTOR VEHICLE MATTERS – PERIOD COVERED. This
POA is designed to clearly express the scope ofthe
authority granted by the licenseetoany attorney(s)-in-
fact. In the space provided, designate all motor vehicle
categories, tax matters,registration or other fee
information under the administration of the NEDMV. If
additional space is required, attach a separate statement
clearlyindicating the matter of the representation.
Motor Vehicle Mattersrequires a brief summary of the
subject for which the attorney-in-fact will represent the
licensee. These may include, but are not limited to: IFTA
and sales and use tax matters, issues relatedto audit of
the licensee’s IRP, IFTA or UCR files, abatement of
penalty, certificate of title or formal hearing.
Period Covered requires a designation of a specific year
or time period. Reference can be made to “all years” or
“all periods”.
AUTHORIZED ACTS.
The POA lists several acts which can
be performed by the attorney-in-fact. This list is intended
to cover the most commonly appointed acts related to
the functions performed by the NEDMV – Motor Carrier
Services Division. The licensee must mark the box to
authorize the named attorney-in-fact regarding a
particular act which is listed. This is important with
respect to correspondence from the NEDMV to the
licensee that may include confidential information or
information covered under the Uniform Motor Vehicle
Records Disclosure Act (UMVRDA). If the licensee does
not want the attorney(s)-in-fact to receive billings, tax
returns, notices, or any other correspondence from the
NEDMV, the licensee will not check the box for this
particular act.Notices of deficiency determinations and
other audit related correspondence, state warrants and
balance due notices will be sent to the licenseedirectly.
A copy will be furnished to the designated attorney(s)-in
fact if the box is checked for the attorney(s)-in-fact to
receive notices. If the licenseewishes to authorize an act
which is not listed, a concise and specific statement
about the additional authorization must be made in the
space provided, or a separatestatement may be
attached to the POA form.
REVOCATION OF POWER OF ATTORNEY
. The POA on file
with the NEDMV will remain in full force and effect
during the time period listed -OR- until such time as the
NEDMV receives written notification from the licensee to
revoke said POA-OR- until the NEDMV receives an
updated POA which will revoke any previous POA on file
with the NEDMV.
SIGNATURE.The licenseeor designee must signand date
the document on the line provided.If the licenseeis a
sole proprietor,the owner(s) must sign.If the licenseeis
a corporation, an officer having authority to bind the
entity must sign. The officer must indicate his or her
official title on the line provided.If the licenseeis a
Nebraska limited liabilitycompany (LLC), all the members
must sign, unless a manager is duly authorized to act in
the name of the LLC. The validity of the authorizations
made by a foreign LLC will be governed by the laws of the
state in which the LLC was organized.If the licenseeis a
partnership all partners must sign, unless one is duly
authorized to act in the name of the partnership.
Nebraska has adopted the Uniform Partnership Act of
1998 (Neb. Rev. Stat. §§ 67-401 to 67-467making each
partner a business agent duly authorized to act for any
partnership formed in Nebraska. Authorized signatures
for nonresident partnerships will be governed by the
laws of the state in which the partnership was formed.