Motor Vehicle Power of Attorney/Odometer Disclosure Sample
HSMV 82995 (REV. 06/21^
STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR SERVICES 2900 Apalachee Parkway - Tallahassee, 32399-0610
(Instructions on Reverse Side)
MOTOR VEHICLE POWER OF ATTORNEY/ODOMETER DISCLOSURE
This form may be used when title is physically held by lienholder or when the title has been lost. This form must be submitted to the state by the person exercising
Powers of Attorney. Failure to do so may result in fines or imprisonment.
VEHICLE DESCRIPTION
Vehicle Identification Number
Year
Make
Model
Body
Title No.
PART A. TRANSFEROR (SELLER'S) POWER OF ATTORNEY TO DISCLOSE MILEAGE.
I/We,
(Print Seller's Name)
appoint
(Print Name of Dealership/Business)
as of
as my/our attorney-in-fact with full authority to transfer title, to satisfy any lien and to disclose the milea ge for the vehicle
(Date)
described above, exactly as stated in the following disclosure.
WARNING: Federal law and State law require that you state the mileage in connection with transfer of ownership. Providing a false stat ement may result in fines or imprisonment.
I/WE STATE THAT THIS 5DIGIT OR 6 DIGIT ODOMETER NOW READS,
,
xx (NO TENTHS) MILES,
DATE READ
, AND I/WE HEREBY CERTIFY THAT TO THE BEST OF0 ................
................
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