Print this form on your printer and return it to the address shown below

POWER OF ATTORNEY

Date: _________________

I/We _________________________________________________________ hereby name and

Appoint _______________________________ to be my/our lawful attorney and to act

                     Name

for me/us to apply for certificate of title or registration.

Year_______________________________________ Make_______________________________

Vehicle Identification Number__________________________________________________

__________________________X____________________________________________________

 Print Owners Name                    Signature of Owner             Date

__________________________X____________________________________________________

 Print Owners Name                    Signature of Owner             Date

_______________________________________________________________________________

Address                City/State          Zip                   Telephone #

The signature of_____________________________________________ was subscribed and

sworn to before me at______________________ NH county of _______________________

on this the _____________ day of______________________________ in the year of .

                                          Notary / Justice of the Peace

                                          Signed ____________________________ _

                                          Printed _____________________________

                                          My commission expires ________________

*THIS FORM MUST BE NOTARIZED*

 Note: Please sign name(s) as they appear on the title.

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Title 5