Form 78003 "Power of Attorney to Transfer Motor Vehicle" - Mississippi

What Is Form 78003?

This is a legal form that was released by the Mississippi Department of Revenue - a government authority operating within Mississippi. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2017;
  • The latest edition provided by the Mississippi Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 78003 by clicking the link below or browse more documents and templates provided by the Mississippi Department of Revenue.

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Download Form 78003 "Power of Attorney to Transfer Motor Vehicle" - Mississippi

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Mississippi
Form 78-003-17-8-1-000 Rev. 09/17
Department of Revenue
MOTOR VEHICLE SERVICES
P.O Box 1383
Jackson, MS 39215-1383
POWER OF ATTORNEY TO TRANSFER MOTOR VEHICLE
This document shall pass with the certificate of title and be included as a support document
to application for new certificate of title and/or application for replacement certificate of title.
THE STATE OF MISSISSIPPI
COUNTY OF _______________________
KNOW ALL MEN BY THESE PRESENT:
THAT I, __________________________________________________________________________________________________
GRANTOR, NAME TO APPEAR IN SAME FORM AS CONTAINED IN CERTIFICATE OF TITLE
________________________________________________________________________________________, OF THE COUNTY OF
(ADDRESS)
________________________________________________________________________and the STATE OF MISSISSIPPI, owner of
the following described motor vehicle, have made, constituted and appointed and by these present do make, constitute and appoint
__________________________________________________________________________________________________________
IF NAME IS LICENSED DEALER, THEN ALSO INCLUDE NAME OF DEALER AUTHORIZED REPRESENTATIVE
_______________________________________________________________________________, OF THE COUNTY OF
(ADDRESS)
________________________________________________________________________ and the STATE OF MISSISSIPPI, my true
and lawful attorney, for me and in my name, place and stead to sell, transfer and assign the motor vehicle described as follows to wit:
MAKE____________________________ V.I.N.___________________________________________
YEAR____________________________ BODY TYPE_____________________________________
TITLE NUMBER______________________________
giving and granting unto my said attorney full power and authority to do and perform all and every act requisite and necessary to transfer
and assign the legal title to said motor vehicle to anyone whomever, as may be designated by said attorney.
FEDERAL and STATE LAW requires that you state the mileage in connection with the transfer of ownership. Failure to complete or
providing a false statement may result in fines and/or imprisonment.
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements
is checked.
_____ 1. I hereby certify that the mileage state is in excess of the mechanical limits of
Odometer Reading
the odometer.
(No Tenths)
_____ 2. The odometer reading is not actual mileage. WARNING-ODOMETER DISCREPANCY
IN WITNESS WHEREOF I HAVE hereunto set my hand this __________________________day of _______________, 20_______ .
______________________________________________________________________
Signature of Owner, Grantor
_____________________________________________________________________
Printed Name of Grantor (if Title is in Company Name, include appropriate Title, Partner, President, Sec. Treas., etc.)
Before me, the undersigned authority, on this day personally appeared_________________________________________________
(Individual Name Only)
known to me to be the person whose name is subscribed to the above foregoing instrument, and acknowledge to me that he executed
the same for the purposes and consideration therein expressed.
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS________________________day of ________________A.D., 20________.
________________________________________________________
Notary Public
Mississippi
Form 78-003-17-8-1-000 Rev. 09/17
Department of Revenue
MOTOR VEHICLE SERVICES
P.O Box 1383
Jackson, MS 39215-1383
POWER OF ATTORNEY TO TRANSFER MOTOR VEHICLE
This document shall pass with the certificate of title and be included as a support document
to application for new certificate of title and/or application for replacement certificate of title.
THE STATE OF MISSISSIPPI
COUNTY OF _______________________
KNOW ALL MEN BY THESE PRESENT:
THAT I, __________________________________________________________________________________________________
GRANTOR, NAME TO APPEAR IN SAME FORM AS CONTAINED IN CERTIFICATE OF TITLE
________________________________________________________________________________________, OF THE COUNTY OF
(ADDRESS)
________________________________________________________________________and the STATE OF MISSISSIPPI, owner of
the following described motor vehicle, have made, constituted and appointed and by these present do make, constitute and appoint
__________________________________________________________________________________________________________
IF NAME IS LICENSED DEALER, THEN ALSO INCLUDE NAME OF DEALER AUTHORIZED REPRESENTATIVE
_______________________________________________________________________________, OF THE COUNTY OF
(ADDRESS)
________________________________________________________________________ and the STATE OF MISSISSIPPI, my true
and lawful attorney, for me and in my name, place and stead to sell, transfer and assign the motor vehicle described as follows to wit:
MAKE____________________________ V.I.N.___________________________________________
YEAR____________________________ BODY TYPE_____________________________________
TITLE NUMBER______________________________
giving and granting unto my said attorney full power and authority to do and perform all and every act requisite and necessary to transfer
and assign the legal title to said motor vehicle to anyone whomever, as may be designated by said attorney.
FEDERAL and STATE LAW requires that you state the mileage in connection with the transfer of ownership. Failure to complete or
providing a false statement may result in fines and/or imprisonment.
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements
is checked.
_____ 1. I hereby certify that the mileage state is in excess of the mechanical limits of
Odometer Reading
the odometer.
(No Tenths)
_____ 2. The odometer reading is not actual mileage. WARNING-ODOMETER DISCREPANCY
IN WITNESS WHEREOF I HAVE hereunto set my hand this __________________________day of _______________, 20_______ .
______________________________________________________________________
Signature of Owner, Grantor
_____________________________________________________________________
Printed Name of Grantor (if Title is in Company Name, include appropriate Title, Partner, President, Sec. Treas., etc.)
Before me, the undersigned authority, on this day personally appeared_________________________________________________
(Individual Name Only)
known to me to be the person whose name is subscribed to the above foregoing instrument, and acknowledge to me that he executed
the same for the purposes and consideration therein expressed.
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS________________________day of ________________A.D., 20________.
________________________________________________________
Notary Public