Signing requirements: Licensee, Agent, and Notary Public must sign.
How to Write
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Step 1 – Licensee Information
The licensee (the one granting authority) may be an individual or business. Complete this top section by providing the licensee’s name, Federal Employer Identification Number (FEIN) or Social Security Number (SSN), telephone number, email address, and IRP Account Number, and Customer ID Number (if applicable).

Step 2 – Agent Information
The agent, or representative, is the attorney-in-fact who will act on the licensee’s behalf. Fill out this section by writing the agent’s name, address, phone number, fax number, and email address. Click or manually check the box that is most appropriate.

Step 3 – Sign in Front of Notary Public
In front of a Notary Public, the vehicle owner must endorse and date the form. Place a checkmark next to the applicable box to indicate whose signature is above.

Step 4 – Ensure Notary Public Completes Form
After witnessing the vehicle owner sign, an official Notary Public must fill out the bottom section of the first page. He or she must include their name, seal, date, and signature. Before signing, the vehicle owner must show the Notary Public a valid form of identification. The Notary Public is required to state the type of identification given. If applicable, he or she must include the number associated with the identification, such as with a driver’s license.

Step 5 – Name the Registrant/Licensee
The state requires the agent (attorney-in-fact) to declare that he/she is authorized to represent the registrant or licensee. On the top of the second page, enter the name of the registrant or licensee and their Federal Employer Identification Number (FEIN) OR Social Security Number (SSN).
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Step 6 – Representative Declaration
After reading through the declaration, the agent must bring this form before a Notary Public and provide his/her name, signature, and current date. The Notary will then notarize the form.
