(Day) (Month) (Year) Owner(s)’ Full Legal Name(s) – 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, www.dor.ga.gov..
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