Fillable Printable Suggested Format for Motor Vehicle Power of Attorney - New Jersey

Suggested Format for Motor Vehicle Power of Attorney - New Jersey

Suggested Format for Power of Attorney

Please cut and paste onto your official company letterhead and submit with

Corpcode Request to the New Jersey Motor Vehicle Commission

Name of Company: ______________________________________________________

Mailing Address: _______________________________________________________

City:__________________________________State: ______ Zip: _________________

Street Address if mailing address is a PO Box: ________________________________

Federal Taxpayer ID#:_______________________ Phone #:______________________

Business Description:_____________________________________________________

Power of Attorney is being authorized for the following motor vehicle business:

[ ] Request corpcode [ ] Title vehicle [ ] Register vehicle

Power of Attorney being granted to

: __________________________________________

(Please print name)

Relationship to Company: __________________________________________

(Must be employed by or hired by your company)

If you plan on titling and or registering vehicle, please provide the following:

(may copy this section multiple times for multiple vehicles)

Vehicle type:_____________ Make:___________________ Model:_________________

Year of vehicle:_______________ VIN or Hull#: ________________________________

Insurance Co. Name:_________________________Policy #: _____________________

Phone #: _____________________

I hereby certify to the accuracy of the above information and that the person to whom

Power of Attorney is being granted and I are both legally residing in the United States.

Print Name and Title of Company Official authorizing Power of Attorney:

_____________________________________ _________________________________

(Name) (Title)

STOP: SIGN IN THE PRESENCE OF A NOTARY

Company Official’s Signature

:________________________________Date:___________

(Must be same person as stated directly above)

Driver License #:________________________ State of Issuance:__________________

Note: A photocopy of the driver license of the company official granting the Power of Attorney and a

photocopy of the individual given the Power of Attorney must be attached to this document.

This space is reserved for Notary Only:

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