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Michigan Power of Attorney for a Vehicle, Watercraft, or Mobile Home Form


Michigan Power of Attorney for a Vehicle, Watercraft, or Mobile Home Form
Michigan Power of Attorney for a Vehicle, Watercraft, or Mobile Home Form
Michigan Department of State
APPOINTMENT OF AGENT
For a Vehicle, Watercraft, or Mobile Home
All Information Must be Completed in Ink
I appoint ___________________________________________________
(agent’s name)
Agent’s address: ____________________________________________
____________________________________________
Agent’s Driver License
Number or ID Card Number: ______________________________________
as my agent to sign my name to legal documents pertaining to the sale or purchase
of the unit described below which is required to be titled under Michigan law.
Year VIN
Make License Plate Number (if any)
Vehicle, Watercraft, or Mobile Home Owner Information
Owner’s Name
Owner’s Street Address City
State Zip Code Daytime Phone Number
( )
Owner’s Driver License or ID Card Number Today's Date
A false statement in connection with a title transaction is a crime.
NOTE: Owner must provide a photocopy of their valid driver
license or state ID card to the agent listed above.
Owner’s Signature:
X
Authorities granted under Public Acts 300 of 1949, 160 of 1978, and 419 of 1976, as amended.
TR-128 (08/13)
Clear Form
Michigan Power of Attorney for a Vehicle, Watercraft, or Mobile Home Form