This form contains 34 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Attorney-in-Fact Name
Attorney-in-Fact Full Name Text
Enter the full legal name of the person you are appointing as your attorney-in-fact (agent) under this power of attorney.
General
Motor Vehicle Checkbox
Check this box if the power of attorney applies to a motor vehicle.
Mobile Home Checkbox
Check this box if the power of attorney applies to a mobile home.
Notarization Date
Notarization Day Text
Enter the day of the month on which the document is notarized.
Notarization Month Text
Enter the month in which the document is notarized.
Notarization Year Text
Enter the year in which the document is notarized.
Notary Public
Notary Commission Expiration Date Date
Enter the date on which the notary public's commission expires.
Notary Venue (State and County)
State (Notary Venue) Text
Enter the U.S. state where the notarization is taking place.
County (Notary Venue) Text
Enter the county where the notarization is taking place.
Owner Signature and Address
Owner Signature Text
Enter the signature of the vehicle/mobile home owner authorizing this power of attorney.
Street Address Text
Enter the owner's street address (house number and street name).
Person Appearing Before Notary
Person Appearing Before Notary Text
Enter the full name of the person who appeared before the notary and was subscribed and sworn.
Principal (Owner) Name
Principal (Owner) Full Name Text
Enter the full legal name of the principal/owner granting this power of attorney.
Vehicle Identification Number (VIN)
VIN character 1 Text
Enter the 1st character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 2 Text
Enter the 2nd character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 3 Text
Enter the 3rd character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 4 Text
Enter the 4th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 5 Text
Enter the 5th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 6 Text
Enter the 6th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 7 Text
Enter the 7th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 8 Text
Enter the 8th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 9 Text
Enter the 9th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 10 Text
Enter the 10th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 11 Text
Enter the 11th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 12 Text
Enter the 12th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 13 Text
Enter the 13th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 14 Text
Enter the 14th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 15 Text
Enter the 15th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 16 Text
Enter the 16th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
VIN character 17 Text
Enter the 17th character of the Vehicle Identification Number (VIN). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
Vehicle/Mobile Home Details (Year, Make, Body Type, Title Number)
Vehicle/Mobile Home Year Text
Enter the model year of the motor vehicle or mobile home. Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
Make Text
Enter the make (manufacturer/brand) of the motor vehicle or mobile home. Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
Body Type Text
Enter the body type of the motor vehicle or mobile home (for example, sedan, pickup, or trailer). Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home
Title Number Text
Enter the certificate of title number for the motor vehicle or mobile home. Fill only if 'Motor Vehicle', 'Mobile Home' is selected (any).
Depends on: Motor Vehicle, Mobile Home