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New Jersey Motor Vehicle Power of Attorney Form


New Jersey Motor Vehicle Power of Attorney Form
New Jersey Motor Vehicle Power of Attorney Form
Suggested Format for Power of Attorney
Please cut and paste onto your official company letterhead and submit with
Corpcode Request to the New Jersey Motor Vehicle Commission
Name of Company: ______________________________________________________
Mailing Address: _______________________________________________________
City:__________________________________State: ______ Zip: _________________
Street Address if mailing address is a PO Box: ________________________________
Federal Taxpayer ID#:_______________________ Phone #:______________________
Business Description:_____________________________________________________
Power of Attorney is being authorized for the following motor vehicle business:
[ ] Request corpcode [ ] Title vehicle [ ] Register vehicle
Power of Attorney being granted to
: __________________________________________
(Please print name)
Relationship to Company: __________________________________________
(Must be employed by or hired by your company)
If you plan on titling and or registering vehicle, please provide the following:
(may copy this section multiple times for multiple vehicles)
Vehicle type:_____________ Make:___________________ Model:_________________
Year of vehicle:_______________ VIN or Hull#: ________________________________
Insurance Co. Name:_________________________Policy #: _____________________
Phone #: _____________________
I hereby certify to the accuracy of the above information and that the person to whom
Power of Attorney is being granted and I are both legally residing in the United States.
Print Name and Title of Company Official authorizing Power of Attorney:
_____________________________________ _________________________________
(Name) (Title)
STOP: SIGN IN THE PRESENCE OF A NOTARY
Company Official’s Signature
:________________________________Date:___________
(Must be same person as stated directly above)
Driver License #:________________________ State of Issuance:__________________
Note: A photocopy of the driver license of the company official granting the Power of Attorney and a
photocopy of the individual given the Power of Attorney must be attached to this document.
This space is reserved for Notary Only:
8/04
New Jersey Motor Vehicle Power of Attorney Form