Illinois Power Of Attorney To Obtain Title Documents Form

Transcript

POWER OF ATTORNEY TO OBTAIN TITLE DOCUMENTS AND ILLINOIS TITLE IN ACCORDANCE WITH ILLINOIS COMPLIED STATUES CHAPTER 770 50/1-50/6 (lien $2,000 or less) CHAPTER 770 45/1 et seq. or CHAPTER 770 90/1 et seq. (lien more than $2,001) 625 ILCS 5/3-117.1 (MECHANIC’S LIEN LAW) I, Please Print Name APPOINT TITLE SERVICES OF ILLINOIS AS MY ATTORNEY IN FACT TO SIGN ALL PAPERS AND DOCUMENTS REQUIRED TO SECURE AN ILLINOIS TITLE FOR THE VEHICLE DESCRIBED BELOW, EXACTLY AS STATED Please Sign Name ILLINOIS DRIVERS LICENSE # DATE OF BIRTH ______/______/______ SEX M ‫ ٱ‬F ‫ٱ‬ EMAIL OWNER‫ ٱ‬MANAGER‫ ٱ‬EMPLOYEE ‫ٱ‬ x @ NAME OF BUSINESS ADDRESS OF BUSINESS CITY STATE ZIP CODE PHONE ( ) __________________________ COUNTY _______________ FAX ) __________________________ LIEN AMOUNT $ __________________ ( (Total of Your Invoice) DATE VEHICLE SERVICE WAS PROVIDED ______/______/______ (This should be the date the vehicle was towed or the date the repairs were started) WHAT IS YOUR NEW OR USED CAR DEALER # ___________________ WHAT IS YOUR ILLINOIS REBUILDER U.D.L. # ___________________ WHAT IS YOUR ILLINOIS REPAIR U.D.L. # ___________________ PHOTOCOPY OF CURRENT DEALER LICENSE, REBUILDER OR REPAIRER UDL MUST BE INCLUDED TO BE TAX EXEMPT. VEHICLE INFORMATION YEAR _________ MAKE ____________________ MODEL ___________________ BODY ____________ VEHICLE IDEN. NO. (VIN) ___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___ • ILLINOIS LICENSE PLATE # ___/___/___/___/___/___/___ 17 Digits EXPIRES MONTH____YEAR_____ OTHER STATE PLATE ? VEHICLE COLOR ____________ TODAY’S DATE _________/__________/_________ Month Day Year I CERTIFY TO THE BEST OF MY KNOWLEDGE THAT THE ODOMETER READING IS THE ACTUAL MILEAGE OF THE VEHICLE ___________________ Actual‫ٱ‬ Not Actual‫ٱ‬