Linda H. Frary
Clerk of Courts, Richland County, Ohio
Power of Attorney
Know all men by these presents, that the undersigned does hereby make, constitute and appoint
My true and lawful attorney-in-fact for me and in my name, place and stead, to make and execute the
assignment of or application for m y Certificate of Title covering the following described m otor vehicle,
Year _____________ Make _____________________ M odel __________________________
Serial Number ______________________________ ____ Body Type ________________________
And granting to my said attorney-in-fact full authority to do and perform all and every act and thing
whatsoever, requisite, necessary and proper to be done in and about the premises as fully and to all
intents and purposes as the undersigned might or could do with full power of substitution and
revocation hereby ratifying and confirming all that said attorney or his substitute shall lawfully do or
cause to be done by virtue hereof.
In Witness Whereof, the undersigned has caused his name to be subscribed hereto this ___________
day of __________________ 20 _____.
SIGNATURE OF PERSON GIVING POWER OF ATTORNEY
SOCIAL SECURITY NUMBER OF BUYER/OWNER
State of Ohio, County of ________________________. Subscribed and sworn to before me a Notary
Public in and for said County personally appeared ______________________________________ who
acknowledged the signing of the foregoing instrument and that such signing is his free act and deed.
In Testimony Whereof, I have hereunto set my hand and affixed my official seal this _______________
day of _________________ 20 _____.
My com m ission expires on ______________________