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Indiana Limited Power of Attorney (Vehicle and Watercraft Transactions) Form

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Indiana Limited Power of Attorney (Vehicle and Watercraft Transactions) Form
Indiana Limited Power of Attorney (Vehicle and Watercraft Transactions) Form
LIMITED POWER OF ATTORNEY
VEHICLE AND WATERCRAFT TRANSACTIONS
State Form 1940 (R4 / 5-13)
INDIANA BUREAU OF MOTOR VEHICLES
INSTRUCTIONS: 1. Complete in blue or black ink. If more than one customer’s signature is required, each customer must complete their own
Limited Power of Attorney section below.
2. Individuals must enter their residential address; companies must enter their principal place of business.
3. The Limited Power of Attorney form must be notarized to be valid.
4. The Limited Power of Attorney designation is valid for ninety (90) days from the date of notarization.
I, _______________________________________________, residing/located at______________________________ in the
county of _________________, State of _____________, do hereby appoint ________________________________________________
as my attorney-in fact for a period of ninety (90) days from the notary date. I authorize the attorney-in-fact to complete transactions involving
the certificate of title and/or registration for the vehicle / watercraft described below.
Vehicle or Hull Identification Number
Make of Vehicle / Watercraft Year Title Number (if known)
Customer’s Signature Customer’s Printed Name
Date (mm/dd/yyyy)
NOTARY CERTIFICATE
STATEOF____________________________________________
SS:(SEAL)
COUNTYOF__________________________________________
Sworn to before me, a Notary Public, in and for said County, this __________day of____________________________, 20_____.
Signature of Notary Public Printed or Typed Name of Notary Public Date Commission Expires (mm/dd/yyyy)
I, _______________________________________________, residing/located at______________________________ in the
county of _________________, State of _____________, do hereby appoint ________________________________________________
as my attorney-in fact for a period of ninety (90) days from the notary date. I authorize the attorney-in-fact to complete transactions involving
the certificate of title and/or registration for the vehicle / watercraft described below.
Vehicle or Hull Identification Number
Make of Vehicle / Watercraft Year Title Number (if known)
Customer’s Signature Customer’s Printed Name
Date (mm/dd/yyyy)
NOTARY CERTIFICATE
STATEOF____________________________________________
SS:(SEAL)
COUNTYOF__________________________________________
Sworn to before me, a Notary Public, in and for said County, this __________day of____________________________, 20_____.
Signature of Notary Public Printed or Typed Name of Notary Public Date Commission Expires (mm/dd/yyyy)
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Indiana Limited Power of Attorney (Vehicle and Watercraft Transactions) Form