Motor Vehicle Power of Attorney - Florida

STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
Neil Kirkman Building -Tallahassee, Florida 32399-0500
POWER OF ATTORNEY FOR A MOTOR VEHICLE, MOBILE HOME OR VESSEL
Date
I hereby name and appoint,
, to be my lawful attorney-
in-fact, to act for me, in applying for an original or duplicate certificate of title, to register, transfer
title, or record a lien to the motor vehicle, mobile home or vessel described below, and to print my
name and sign their name, in my behalf. My attorney-in-fact can also do all things necessary to
the application or any other related instrument and to bind me in as sufficient a manner as I myself
could do, were I personally present and signing the same.
With full power of substitution and revocation, I hereby ratify and confirm whatever my said
attorney-in-fact may lawfully do or cause to be done in the virtue hereof.
Motor Vehicle
CHECK ONE: Mobile Home Vessel
Make/Manufacturer
Identification Number
Year
Title Number
Model
Vessel Registration Number
Body
Wt.-Lgth.-BHP
NOTICE TO OWNER: COMPLETE THIS FORM IN ITS ENTIRETY PRIOR TO SIGNING.
Signature of Owner / Co-owner (Grantor)
Street Address of Owner / Co-owner (Grantor)
City
State
Zip
Date of Birth
Driver License Number
day of
Sworn to (or affirmed) and subscribed before me this
By:
(Name of Person Making Statement)
(Print, Type or Stamp Commissioned Name of Notary)
(SEAL)
(Signature of Notary)
Personally Known
or Produced Identification
Type of Identification Produced
Section 328.05, Florida Statutes, and Section 319.33, Florida Statutes, provides that whoever
knowingly makes a false statement in any application or affidavit required under the provisions of
such Chapter, or in a bill of sale or sworn statement of ownership, or otherwise commit a fraud in
any application, is guilty of a felony of the third degree, punishable as provided in s.775.082,
775.083, and 775.084.
If a power of attorney is used and the individual appointed as the attorney-in-fact will be
completing the odometer disclosure statement as the buyer only or the seller only, this non-secure
power of attorney form can be used. This form can not be used to allow an individual or entity to
sign as both buyer and seller confirming the Federal odometer reading. This may be
accomplished only with the secure power of attorney (HSMV 82995) when:
the title is physically being held by the lienholder; or
the title is lost
(a)
(b)
CAUTION: A seller cannot give a dealer or his employee a non-secure power of attorney (HSMV
82053) and have him or one of his employees sign a federal odometer statement, confirming the
mileage for both buyer and seller, as a dealer and his employees are considered a single entity.
(MERGED VVITH FORM HSMV 87005)
HSMV 82053 (Rev. 6199) S
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