POWER OF ATTORNEY
|[pic] |OHIO DEPARTMENT OF PUBLIC SAFETY | |
| |BUREAU OF MOTOR VEHICLES | |
| | | |
| |POWER OF ATTORNEY | |
|Know all men by these presents, that the undersigned does hereby make, constitute and appoint |
|LAST NAME (Including Suffix: Sr. Jr. III etc.) |FIRST NAME |MI |
| | | |
|STREET ADDRESS |CITY |STATE |ZIP CODE |
| | | | |
|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 my Certificate of Title |
|covering the following described motor vehicle, to-wit: |
|MAKE |YEAR |VIN. |
| | | |
|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/her substitute shall lawfully do or cause to be done by virtue hereof. |
|In Witness whereof, the undersigned has caused his/her name to be subscribed hereto this |
|day of , 20 . |
|PRINTED NAME OF PERSON GIVING POWER OF ATTORNEY |
| |
|LAST 4 DIGITS OF SOCIAL SECURITY NUMBER OF PERSON GIVING POWER OF ATTORNEY |
| |
|SIGNATURE OF PERSON GIVING POWER OF ATTORNEY |
|X |
|ACKNOWLEDGEMENT |
|Notary: |
|Sworn to and subscribed in my presence this _______ day of , 20 in County, |
|State of . |
|(Notary Seal) |
|X My commission expires |
|Signature of Notary Public or other Authorized Officer by law |
|NOTE: A motor vehicle dealer licensed in accordance with 4517 of the Ohio Revised Code (R.C.), who is the owner or purchaser of the motor vehicle, is not required |
|to have this document notarized under section 4505.063 of the R.C. |
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