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Form 82995- Secure Power of Attorney



Use this form when the title is lost, the title is being held by a lienholder, or it is being held electronically and remaining electronic.


Part A is completed by the owner to the dealership.  The owner discloses the odometer reading to the dealership.  The owner is giving the dealership Power of Attorney to execute the title when it becomes available. 


Part C is completed by a representative of the dealership when the title is received, The person who completes Part C must be the person who executes the title.


Part B can be completed if the car is sold before the title becomes available.  In Part B, the dealership (now the seller) discloses the odometer to the purchaser (the customer).


The representative from the dealership who signs in Part A, B, & C does not need to be the same person, but the representative who signs Part C must be the one to transfer information over to the title and sign as Power of Attorney.

Vehicle Description


  1. Vehicle Identification Number

Enter the VIN number


  1. Year

Enter the Year


  1. Make

Enter the Make


  1. Body

Enter the Body Type. 


  1. Title No

Enter the title number here


Part A- Seller’s Power of Attorney to Disclose Mileage


Since the title is unavailable, Part A is used as the Federal Odometer Disclosure between the seller and the purchaser.  When the title is received, the information disclosed in Part A will be transferred onto the title.


  1. Print Seller’s Name

The seller’s printed name goes in this area.


  1. Print Name of Dealership/Business

The dealership’s name goes here.


  1. Date

Date of appointment


  1. 5 or 6 Digit Odometer (check the appropriate box)

Remember- most digital odometers are 6 digits.


  1. Odometer Reading

The odometer reading goes in these boxes.  Make sure the reading is accurate

and there are no cross-outs or write-overs.


  1. Date the Odometer Read

Enter the date of the odometer reading.



  1. Odometer Certification (check the appropriate box)
  • Reflects ACTUAL mileage
  • Is in EXCESS of its mechanical limits
  • Is NOT ACTUAL mileage


  1. Seller’s Signature


  1. Seller’s Printed Name


  1. Co-Seller’s Signature (if applicable)


  1. Co-Seller’s Printed Name (if applicable)


  1. Seller’s Street Address

Complete this row with the seller’s complete address.


  1. Purchaser’s Signature

A representative from the dealership signs his name.


  1. Purchaser’s Printed Name

The same representative prints his name.


  1. Purchaser’s Dealership Name

The name of the dealership goes here.


  1. Dealer License No.

Put the dealer license number here.


  1. Business Address

Put the dealership’s physical address on this row.



Part C Certification By Attorney In Fact

(This Person Signs The Title)


  1. POA Printed Name
  2. POA Signature
  3. Date
  4. POA Printed Name
  5. POA Address






Both Part A and Part C will be completed,




Parts A, B, & C will be completed.


NEVER only Parts B & C.

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