Form Hsmv 96440 PDF Details

In the realm of commercial vehicle operations and tax compliance within the United States, the HSMV 96440 form serves a crucial role by establishing a legal power of attorney (POA) and declaration by an authorized agent. This form, overseen by the Division of Motorist Services Bureau of Commercial Vehicle and Driver Services, facilitates the delegation of authority from registrants or licensees to designated representatives, enabling these agents to carry out specific acts related to the International Registration Plan (IRP) and the International Fuel Tax Agreement (IFTA). Notably, the form requires detailed information about the registrant or licensee, including their FEIN and contact details, alongside the authorized agent’s particulars and the scope of authorized activities. This authority spans the submission of transactional forms, receipt of credentials, and audit representation, excluding actions that could financially bind the registrant or licensee or require their attestation. Furthermore, the form elucidates the procedure for its validation, which necessitates signatures from both the principal and the agent in the presence of a notary, thus underscoring the importance of accuracy and truthfulness under penalties of perjury. This essential document underscores the regulatory compliance requirements inherent in commercial vehicle operation and tax matters, highlighting a structured process for delegating authority within the legal and operational frameworks of the transport sector.

QuestionAnswer
Form NameForm Hsmv 96440
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform 96440 fill out online, fl dmv power of attorney form, hsmv96440, florida form 96440

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Division of Motorist Services

Bureau of Commercial Vehicle

and Driver Services

POWER OF ATTORNEY (POA)

AND DECLARATION BY AUTHORIZED AGENT

PART 1 – POWER OF ATTORNEY

Section 1. Registrant/Licensee

Print Name: _____________________________________________________________

FEIN: _____________________________________________________________________

Telephone Number: (___________)______________________________________

The name and FEIN entered on this POA (Form 96440) must match the name and FEIN that is on the IRP and IFTA accounts referenced below:

IRP Account Number: ______________________________________

Email Address: __________________________________________________________

IFTA Account Number: ____________________________________

Section 2. Authorized Agent (Representative)

Print Name: __________________________________________________________________________

Address: ______________________________________________________________________________

__________________________________________________________________________________________

This is an individual and the sole authorized agent who may represent me.

This is a motor carrier service provider company. I understand the Department must be provided a complete list of all company employees who are authorized agents, with their printed names, actual signatures, and photocopies of their driver licenses.

Agent’s Main Telephone Number:

(_________)___________________________________________

Agent’s Main Fax Number:

(_________)___________________________________________

Agent’s Main Email Address:

______________________________________________________

Section 3. Acts Authorized by the Registrant/Licensee

A photocopy of the Registrant/Licensee’s Driver License must be filed with this FORM 96440

I authorize the representative described in Section 2 to receive and inspect confidential information and transact on my behalf with respect to both my International Registration Plan (IRP) and my International Fuel Tax Agreement (IFTA) accounts, which I have listed in Section 1. This authority specifically includes the power to fill out and submit IRP/IFTA transactional forms, receive IRP and IFTA credentials; and represent the Registrant/Licensee in audit and/or collection matters. This authority does not include the power to endorse or cash warrants; execute consents for compromise and closing agreements that financially bind the Registrant/Licensee; or to sign applications requiring attestation from the Registrant/Licensee. I also understand that filing this POA revokes all earlier POA(s) on file with the Department. Under penalties of perjury, I affirm that I am authorized to execute this Power of Attorney and I declare that the information in the foregoing Sections 1 and 2 are true and correct.

Signature:_________________________________________________________________ Title:__________________________________________ Date:_______________

Registrant/Licensee/Sole Proprietor

A Corporate Officer of the Carrier Company (SUNBIZ REGISTRATION)

Partner in the Carrier Company (MUST HAVE SUNBIZ REGISTRATION AND AUTHORITY TO ACT ON BEHALF OF PARTNERSHIP)

TO BE COMPLETED BY A NOTARY:

The above has been sworn to (or affirmed) and subscribed before me this __________ day of ________________________, 20__________, by:

(Print, Type or Stamp Commissioned) Name of Notary

Signature of Notary

 

 

_______________________________________________

_____________________________________________________________

 

 

 

 

 

 

 

Personally Known

 

Produced Identification

SEAL

 

 

 

 

 

 

 

 

Type of Identification Produced:

 

 

 

 

 

 

 

 

 

 

HSMV 96440 (REV. 12/2017)

Page 2

Name of Registrant/Licensee: _______________________________________________FEIN:________________________________

PART II – DECLARATION OF AUTHORIZED AGENT (REPRESENTATIVE)

I understand that the Power of Attorney (POA) on the forgoing page of this Form 96440 is not valid until it is signed and dated by the Registrant/Licensee in the presence of a notary; the Declaration of Authorized Agent (Representative) on the present page is signed and dated by me; and this completed (two-page) Form 96440 has been filed with the Department of Highway Safety and Motor Vehicles, Division of Motorist Services, Bureau of Commercial Vehicle and Driver Services.

Under penalties of perjury, I declare that:

•With respect to the forgoing POA related to the International Registration Plan(IRP) and the International Fuel Tax Agreement (IFTA), I am the individual (or officer of the motor carrier service provider company) authorized to represent the Registrant/Licensee identified in Section 1, in the matters specified in Section 3.

•If applicable, I have attached (or have previously filed with the Bureau of Commercial Vehicle and Driver Services) a complete list of the printed names, respective signatures, and copies of the driver licenses of all authorized agents employed by my company to represent IRP Registrants and IFTA Licensees.

•I am (and if applicable, the authorized agents of my company are) familiar with the plan requirements of the IRP and IFTA, as well as the related provisions of Chapters 207 and 320 Florida Statutes.

•I am (and if applicable, the authorized agents of my company are) familiar with the business procedures of the Bureau of Commercial Vehicle and Driver Services as they relate to IRP and IFTA transactions, and I am (we are) willing and able to follow these procedures on behalf of the Registrant/Licensee.

•The Authorized Agent information provided in Section 2 of the forgoing document is true and correct.

Printed Name

Signature

Date

Name of the Service Provider Company (if applicable)

HSMV 96440 (REV. 12/2017)

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Filling in segment 1 of fl power of attorney form dmv

2. Soon after filling in this part, go to the next step and enter the essential particulars in these blank fields - Section Acts Authorized by the, RegistrantLicenseeSole Proprietor, A Corporate Officer of the Carrier, TO BE COMPLETED BY A NOTARY The, Signature of Notary Personally, HSMV Rev, and SEAL.

fl power of attorney form dmv completion process clarified (portion 2)

As to HSMV Rev and A Corporate Officer of the Carrier, be sure that you don't make any errors in this section. These two could be the most important ones in the file.

3. Completing Page, Name of RegistrantLicensee FEIN, With respect to the forgoing POA, and International Fuel Tax Agreement is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Ways to fill in fl power of attorney form dmv step 3

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