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Maryland Restricted Power of Attorney Form


Maryland Restricted Power of Attorney Form
Maryland Restricted Power of Attorney Form
Maryland Development Group, Inc. t/a
Maryland Auto and Truck Repair
MVA Identity #TSA0325
512 B Crain Highway North, Glen Burnie, MD 21061
Tag and Title Service
Tel 410-760-8123, Fax 410-760-7094
Restricted Power of Attorney
I hereby ratify and confirm all acts performed by my/our agent within the scope of this restricted power
of attorney regarding the motor vehicle shown below. I certify, under penalty of perjury, that the
statements made herein are true and correct, to the best of my/our knowledge, information, and belief.
I _____________________________________________________________________
Address _______________________________________________________________
Do hereby authorize ______________________________________________________
A representative of the Maryland Development Group, Inc. DBA Maryland Auto and Truck Repair to
act for me/us in all matters pertaining to the licensing and/or execution of an assignment concerning the
following vehicle:
VIN
YEAR
MAKE
MODEL
DL #
INSURANCE CO
POLICY
#
Signature of first grantor: _______________________________________________
Signature of second grantor: _____________________________________________
Signature of third grantor: _______________________________________________
Maryland Restricted Power of Attorney Form