Fillable Printable BMV 3771 - Power of Attorney Form - Ohio Bureau of Motor Vehicles

BMV 3771 - Power of Attorney Form - Ohio Bureau of Motor Vehicles

BMV 3771 4/15 [760-1503]

Ohio Bureau of Motor Vehicl es

POWER OF ATTORNEY

Know all men by these presents, that the undersigned does hereby make, constitute and appoint

LAST NAME

FIRST NAME

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

SERIAL NO.

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 substitute shall lawfully do or cause to be done by virtue hereof.

In Witness whereof, the undersigned has caused his name to be subscribed hereto this

day of , 20 .

SIGNATURE OF PERSON GIVING POWER OF ATTORNEY SOCIAL SECURITY NUMBER OF BUYER/OWNER

ACKNOWLEDGEMENT

State of Ohio, County of . Subscribed and sworn to before me a Notary Public in

and for said County personally appeared who

acknowledged the signing of the foregoing instrument and that such signing is his free act and deed.

In Testimony Whereof, I have hereunto set my hand and affixed my official seal

this day of , 20 in the county of State of Ohio.

NOTARY PUBLIC

My commission expires ___