For a Vehicle, Watercraft, or Mobile Home
Michigan Department of State
APPOINTMENT OF AGENT
Clear Form
For a Vehicle, Watercraft, or Mobile Home
NOTE: This form CANNOT be used for either of the following:
? To apply for an instant title, unless the Agent is a licensed vehicle dealer.
? To appoint an Agent who would be signing a title, or application for title,
as both the buyer and seller of a vehicle, watercraft, or mobile home.
All Information must be completed in ink.
I appoint ___________________________________________________
(agent¡¯s name)
Agent¡¯s address: ____________________________________________
____________________________________________
Agent¡¯s Driver License
Number or ID Card Number: ______________________________________
as my agent to sign my name to legal documents pertaining to the sale, purchase
or titling of the unit described below as required by Michigan law. I am voluntarily
making this appointment and am aware that I may bear responsibility for any
information provided by, or actions taken by my agent.
Year
VIN
Make
License Plate Number (if any)
Vehicle, Watercraft, or Mobile Home Owner Information
Owner¡¯s Name
Owner¡¯s Street Address
State
City
Zip Code
Owner¡¯s Driver License or ID Card Number
Daytime Phone Number
Today¡¯s Date
A false statement in connection with a title transaction is a crime.
NOTE: Owner must provide a photocopy of their valid driver's license
or state ID card with this form. Agent will present this completed form
and required photocopy to the Secretary of State branch.
Owner¡¯s Signature:
X
Authorities granted under Public Acts 300 of 1949, 451 of 1994, and 96 of 1987, as amended. TR-128
(05/24)
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