RT5
User Manual: RT5
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Print Secretary of State Power of Attorney Reset Save Secretary of State This space for use by Secretary of State Power of Attorney Secretary of State Vehicle Services Department 501 S. Second St. Springfield, IL 62756 Secretary of State Vehicle Services Department 501 S. Second St. Springfield, IL 62756 www.cyberdriveillinois.com www.cyberdriveillinois.com This space for use by Secretary of State , , Name of individual appointing power of attorney Name of individual appointing power of attorney whose address is , whose address is , does hereby make, constitute and appoint , does hereby make, constitute and appoint , whose address is , whose address is , as the lawful attorney in fact, to sign all papers and documents required to secure Illinois title and/or registration of, or transfer interest in, the following described vehicle: as the lawful attorney in fact, to sign all papers and documents required to secure Illinois title and/or registration of, or transfer interest in, the following described vehicle: Vehicle Make: Model Year: Vehicle Make: Model Year: Vehicle Model: Body Type: Vehicle Model: Body Type: Vehicle Identification Number (VIN): Vehicle Identification Number (VIN): Complete the following (if applicable): Complete the following (if applicable): Purchaser’s Name: Purchaser’s Name: Address: Address: Date of Sale: Date of Sale: Granting to the aforesaid attorney in fact full power to do all acts as the principal might or could do if personally present; and hereby ratifying and confirming all that said attorney in fact shall lawfully do or cause to be done by virtue of the authority herein given for this purpose. Granting to the aforesaid attorney in fact full power to do all acts as the principal might or could do if personally present; and hereby ratifying and confirming all that said attorney in fact shall lawfully do or cause to be done by virtue of the authority herein given for this purpose. Such authority shall in no way reflect upon the State of Illinois, Secretary of State, or the Director of the Vehicle Services Department. Such authority shall in no way reflect upon the State of Illinois, Secretary of State, or the Director of the Vehicle Services Department. Signed Signed Date Signed Date Signed ♻ Printed on recycled paper. Printed by authority of the State of Illinois. July 2010 — 100M — RT 5.10 ♻ Printed on recycled paper. Printed by authority of the State of Illinois. July 2010 — 100M — RT 5.10
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