Fillable Printable HSMV 82053 - Power of Attorney Form - Florida
Fillable Printable HSMV 82053 - Power of Attorney Form - Florida
HSMV 82053 - Power of Attorney Form - Florida
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SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
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POWER OF ATTORNEY FOR A MOTOR VEHICLE, MOBILE HOME OR VESSEL
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I/We hereby name and appoint, __________________________________________________________, to be my/our
(Full Legibly Printed Name is Required)
lawful attorney-in-fact, to act for me/us, in applying for an original or duplicate certificate of title, to register, transfer title,
or record a lien to the motor vehicle, mobile home or vessel described below, and to print my/our name and sign their
name, in my/our behalf. My attorney-in-fact can also do all things necessary to the application or any other related
instrument and to bind me/us in as sufficient a manner as I/we myself/ourselves could do, were I/we personally present
and signing the same.
With full power of substitution and revocation, I/we hereby ratify and confirm whatever my/our said attorney-in-fact may
lawfully do or cause to be done in the virtue hereof.
CHECK ONE: Motor Vehicle Mobile Home Vessel
Year
Make/Manufacturer Body Type Title Number
Vehicle/Vessel Identification Number
NOTICE TO OWNER(S): COMPLETE THIS FORM IN ITS ENTIRETY PRIOR TO SIGNING.
UNDER PENALTIES OF PERJURY, I/WE DECLARE THAT I/WE HAVE READ THE FOREGOING DOCUMENT AND
THAT THE FACTS STATED IN IT ARE TRUE.
_________________________________________________ __________________________________________________
(Signature of Owner "Grantor”)
(Legibly Printed Name of Owner "Grantor")
________________________________________________________________________________________________________
(Driver License, Identification Card or FEID Number for Owner)
(Date of Birth for Owner, if applicable)
________________________________________________________________________________________________________
(Owner’s Address )
(City) State) (Zip)
_________________________________________________ __________________________________________________
(Signature of Co-Owner "Grantor,” if applicable) (Legibly Printed Name of Co-Owner "Grantor," if applicable)
________________________________________________________________________________________________________
(Driver License, Identification Card or FEID Number for Co-Owner)
(Date of Birth for Co-Owner, if applicable)
________________________________________________________________________________________________________
(Co-Owner’s Address)
(City) (State) (Zip)
This non-secure power of attorney form may be used when an individual or entity appointed as the attorney-in-fact will
be completing the odometer disclosure statement as the buyer only or the seller only. However, this form cannot be
used to allow an individual or entity (such as a dealership) to sign as both buyer and seller for the purpose of disclosing
the odometer reading. This may be accomplished only with the secure power of attorney (HSMV 82995) when:
(a)
the title is physically being held by the lienholder; or
(b) the title is lost.
NOTE: A licensed dealer and his/her employees are considered a single entity.
Check your local phone book government pages or visit the following website for current mailing addresses:
http://www.flhsmv.gov/offices/
HSMV 82053 (Rev. 12/11) S
www.flhsmv.gov
