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Printed or Typed Owner(s)’ Signature(s) Acknowledgement of Notary Public The undersigned notary public does hereby certify that the above-named owner of the vehicle identified in this appointment of an attorney-in-fact, executed this form in my presence and that said owner was proven to be the person named by the use of the following form of positive, picture identification: Owner(s)’ Valid Driver’s License Number(s) Issuing State(s) Sworn to and subscribed before me: This day of , Day Notary’s Full Legal Name - Printed or Typed Notary’s Signature Seal or Stamp Date My Notary Commission Expire) Month Year Notary’s Street Address Notary’s City, State Zip Notary Public’s Phone or e-mail address This form can be electronically completed and printed for signing and submission from the Department of Revenue’s website
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