VERMONT MOTOR VEHICLE POWER OF ATTORNEY

KNOWN BY ALL PERSONS BY THESE PRESENTS, that [PRINCIPAL NAME] (“Principal”)  with a mailing address of [PRINCIPAL ADDRESS] grants to [AGENT NAME] (“Agent”) with a mailing address of [AGENT ADDRESS] or its designated representative for an indefinite period of time or until canceled in writing, a limited power of attorney, to act on its/his/her behalf, with regard to all matters pertaining to the registering, licensing, transfer of ownership, and/or titling of the vehicle listed below with the applicable motor vehicle agency in the State of Vermont.

Year: [VEHICLE YEAR] Make: [VEHICLE MAKE] Model: [VEHICLE MODEL]
VIN: [VEHICLE IDENTIFICATION NUMBER] Odometer: [ODOMETER READING]
Principal’s Date of Birth: [MM/DD/YYYY]
Principal’s Social Security Number (SSN): [#]

PRINCIPAL’S SIGNATURE: _____________________________ Date: [MM/DD/YYYY]

AFFIRMATION BY WITNESS

I, [WITNESS NAME], witnessed the execution of this Power of Attorney by the Principal, and I affirm that the Principal appeared to me to be of sound mind, was not under duress, and the Principal affirmed to me that he/she was aware of the nature of this Power of Attorney and signed it freely and voluntarily.

WITNESS SIGNATURE:                                                       

Print Name: [WITNESS NAME]

NOTARY ACKNOWLEDGMENT

STATE OF [STATE]
COUNTY OF [COUNTY] ss.

Before me personally appeared the above-named [PRINCIPAL NAME], acting as Principal for the above-mentioned vehicle and duly acknowledged the foregoing instrument to be his/her free act and deed in his/her individual capacity or, if the representative of a company, acknowledges that he or she is duly authorized to sign the foregoing instrument on behalf of the company.

NOTARY SIGNATURE: ___________________________________

Print Name: [NOTARY NAME]
My Commission Expires: [MM/DD/YYYY]

(Seal)