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
City
State
Zip Code
Daytime Phone Number
Owner's Driver License or ID Card 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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