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    Limited Power of Attorney 2021-09-10

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    siyarizliyor

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    © All Rights Reserved
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    Limited Power of Attorney 2021-09-10

    Uploaded by

    siyarizliyor
    19 views1 page

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    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    19 views1 page

    Limited Power of Attorney 2021-09-10

    Uploaded by

    siyarizliyor

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Wyoming Department of Transportation WYDOT Motor Vehicle

    Services
    Motor Vehicle Services 5300 Bishop Blvd
    Limiter Power of Attorney (POA) Form Cheyenne WY 82009
    MVS@wyo.gov
    307-777-4829 (IRP)
    307-777-4827 (IFTA)

    Wyoming based carriers with an International Registration (IRP) and/or an International Fuel Tax Agreement
    (IFTA) account(s) may authorize agents to perform transactions on their behalf by Power of Attorney (POA), using
    this form. This form must be signed by the IRP registrant/IFTA licensee before a notary public. By signing this
    POA, the IRP registrant/IFTA licensee revokes any and all previously executed POAs on file with Motor Vehicle
    Services.

    Motor Carrier / Registrant / Licensee Information


    Company Name: FEIN:
    Printed Name: USDOT:
    Title: □Owner □Partner □Corporate Officer □Member of LLC Wy Account #:
    Address:
    Email: Phone:

    Authorized Agent (Representative)


    Company Name: Phone:
    Printed Name:
    Address:
    Email:
    This is a motor carrier service provider company This is an individual and the sole authorized agent who may
    represent me

    Acts Authorized by the Motor Carrier / Registrant / Licensee


    I authorize the representative listed above to communicate with the Wyoming Motor Vehicles Services (MVS) section with
    respect to both my International Registration (IRP) and my International Fuel Tax Agreement (IFTA) accounts listed above.
    This authority specifically includes: the power to fill out and submit IRP/IFTA applications and renewal forms; to add, delete
    or update vehicle information; to receive IRP and IFTA credentials; to file and authorize payments for IRP registration fees
    and IFTA tax returns; and to provide supporting documentation as requested by MVS. This limited Power of Attorney form
    does not relieve the motor carrier from the responsibility of filing timely, accurate reports and applications.
    Signature: Date:
    Printed Name: Title:

    To be completed by a notary:
    The above registrant has been sworn to (or affirmed) and subscribed before me this day of
    , 20 by:
    Personally Known Produced Identification
    Type of Identification produced:

    Seal &
    Signature

    Eff 09/10/2021

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