The undersigned representative of (the Company), with it principle place of business at (street address, city and state), do hereby swear or certify that the Company is the owner of the motor vehicle described herein.
The Company establishes ownership of the vehicle under an:
To the following described motor vehicle:
Vehicle Year, Make and Model:
Vehicle Identification Number:
State of Registration:
As the authorized representative of the Company, I further swear or certify that towing company, TDLR license # is appointed as the Company’s lawful attorney-in-fact (referred to as “the Agent”) on the following terms and conditions:
The Agent is authorized to act for me under this Specific Power of Attorney as described herein.
The Agent may act and exercise power, authority and control on my behalf, with regard to the motor vehicle described herein.
This Specific Power of Attorney shall expire the earlier of three (3) days from its date of execution, or at an earlier date if revoked by me in writing, or when the motor vehicle is in the possession of the Company.
Signed this ,day of , 20.
Printed Name of Representative and Title
Signature of Authorized Representative:
Subscribed and sworn to before me on this
Notary Public, State of
My commission expires