Montana county and state authorities reserve the right to reject any form that has been altered.
MV65 (4/14) This form is available in alternate formats for people with disabilities.
Title and Registration Bureau
Power of Attorney
MVD Use Only
1003 Buckskin Drive, Deer Lodge, MT 59722-2375 Phone (406) 444-3661 Fax (406) 846-6039
The power of attorney must be exercised by the person or company named on this form, and is only valid on the title
or on the document for which the authority is granted.
If an individual holds the power of attorney, that person must write the name of the owner, followed by his/her
signature and "POA." Example: Sharon Smith by Jane Doe POA (Sharon Smith is the owner and Jane Doe is the
person named as representative on the power of attorney).
If a business holds the power of attorney, the representative of that business must write the name of the owner
followed by the name of the business, and then his/her signature and "POA." Example: Sharon Smith by Morrison's
Garage George Morrison POA.
The vehicle owner/applicant must complete this section:
I (print your legal name)
Address, City, State and Zip Code
Appoint (print the name of the business or individual)
City State Zip Code
as my attorney in fact with full authority to execute any and all instruments, documents, affidavits, etc. to effect
registration, transfer of title, application for title, or
in my place and stead on the following motor vehicle/vessel:
Year Make Model
Vehicle Identification Number
Color License Plate Number
I state that the (check one) five or six digit odometer now reads (no tenths) miles,
date read and to the best of my knowledge it reflects the actual mileage unless one of the
following statements is checked:
DO NOT CHECK
The odometer reading reflects the amount of mileage in excess of its mechanical limits.
The odometer reading is not the actual mileage. Warning – odometer discrepancy.
Under penalty of law (MCA 45-7-203), I certify that the statements made and information contained on this form are
true and correct to the best of my knowledge, information, and belief; I am the person named on this form; and, if
signing for a business entity or trust, I have full authority to do so.
Owner/Applicant Signature: Date:
Notary Use Only:
State of County of Signed before me on
by (clearly print name of person signing form)
(if applicable): I certify that the odometer reading made above by the vehicle owner/applicant is correct.
Purchaser's signature (this is my legal signature—only one signature is required) Purchaser's printed name
If applicant is a firm or corporation, print full name