COMPLIANCE DIVISION/Tow Truck/Vehicle Storage Program
P.O. Box 12157, Austin TX 78711

Email: Towing@tdlr.texas.gov Website Address: www.tdlr.texas.gov

Retrieval of Motor Vehicle by Lien Holder

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:

unrecorded lien holder with a right of possession, orlien holder with an affidavit of repossession (a copy of which is attached hereto)

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:

1) Authority to Act. The Agent is authorized to act for me under this Specific Power of Attorney as described herein.

Powers of Agent. The Agent may act and exercise power, authority and control on my behalf, with regard to the motor vehicle described herein.

The authority granted herein is limited to making payment to and obtaining release of the referenced vehicle from (name of Vehicle Storage Facility).

2) Durability. 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 day of , 20.

Notary Public, State of

My commission expires:

This is a legal document and is provided as a courtesy free of charge. This document affects your legal rights and may give others access to you motor vehicle. If you do not understand this document or have questions, please consult an attorney. Blank lines render this form invalid and of
no consequence.