(no tenths)
P.O. Box 201431, 302 N Roberts, Helena, MT 59620-1431 |
Phone (406) 444-3661 Fax (406) 444-0116 mvdtitleinfo@mt.gov |
The power of attorney must be exercised by the person or company named on this form, and is only valid on the title or on the document for which the authority is granted.
If an individual holds the power of attorney, that person must write the name of the owner, followed by his/her signature and "POA." Example: Sharon Smith by Jane Doe POA (Sharon Smith is the owner and Jane Doe is the person named as representative on the power of attorney).
If a business holds the power of attorney, the representative of that business must write the name of the owner followed by the name of the business, and then his/her signature and "POA." Example: Sharon Smith by Morrison's Garage George Morrison POA.
The vehicle owner/applicant must complete this section:
I (print your legal name) |
Address, City, State and Zip Code |
Appoint (print the name of the business or individual)
Address |
City |
State |
Zip Code |
Email Address |
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Phone Number |
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as my attorney in fact with full authority to execute any and all instruments, documents, affidavits, etc. to effect registration, transfer of title, application for title, or
in my place and stead on the following motor vehicle/vessel:
Vehicle Identification Number
I state that the (check one)
five or
six digit odometer now reads miles,
date readand to the best of my knowledge it reflects the actual mileage unless one of the following statements is checked:
DO NOT CHECK
UNLESS APPLICABLE
Under penalty of law (MCA 45-7-203), I certify that the statements made and information contained on this form are true and correct to the best of my knowledge, information, and belief; I am the person named on this form; and, if signing for a business entity or trust, I have full authority to do so.
Owner/Applicant Signature: |
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Date: |
Notary Use Only:
by (clearly print name of person signing form)
Signed before me on (date)
Notary signature
Purchaser (if applicable): I certify that the odometer reading made above by the vehicle owner/applicant is correct.
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Purchaser's signature (this is my legal signature—only one signature is required) |
Purchaser's printed name |
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Date |
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If applicant is a firm or corporation, print full name |
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MV65 (1/18) |
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Montana county and state authorities reserve the right to reject any form that has been altered. |
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This form is available in alternate formats for people with disabilities. |