Form MV65 PDF Details

In the form MV65, attorney-in-fact can be granted full authority to execute any and all instruments, documents, affidavits, etc., to effect registration, transfer of title, application for title, or act in the owner's place for the specified motor vehicle or vessel.

The form requires the vehicle owner to provide their legal name, address, and the name and address of the appointed business or individual. The form also requires information about the motor vehicle or vessel, such as title number, year, make, model, vehicle identification number, color, and license plate number. Additionally, the form includes a section for odometer reading information and related statements, if applicable.

The vehicle owner must sign the form and have it notarized. If the purchaser is involved, they should also certify the odometer reading by signing the form. If the applicant is a firm or corporation, the full name should be printed.

QuestionAnswer
Form Name Montana Form MV65
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names mv65, mt vehicle poa

Form Preview Example

MV-65 (9/11)

New York State Department of Motor Vehicles

VEHICLE ESCORT DRIVER APPLICATION

PLEASE PRINT WITH BLUE OR BLACK INK IN THE BOXES

 

www.dmv.ny.gov

 

Note: To become a certified vehicle escort driver, you MUST:

 

Have a valid driver license

Pay a $40 fee

Present proof of ID

Be at least 21 years old

Pass a written exam

(as listed on ID-44)

Action Wanted:

oOriginal Certification

oRenewal

oReplace Certificate

o Amend Certification

 

 

 

 

Note: If you are a New York licensed driver and need to change your name and/or address, you must notify DMV of any change BEFORE you submit this application to the Bus Driver Unit.

If you are applying for a replacement or need to change your name and/or address on your certificate, complete this form and mail it to: NYS Department of Motor Vehicles, Bus Driver Unit, 6 Empire State Plaza,Room220C,Albany, NewYork12228. A $5.00 check (payabletotheCommissionerofMotorVehicles) is requiredfor a replacement certificate.

If you are applying for a renewal, complete this form and mail it to: Department of Motor Vehicles, 207 Genesee Street, Utica, NY 13501-2874. A $40 check (payable to Commissioner of Motor Vehicles) is required for a renewal.

Name of Applicant (Last, First, Middle)

Phone Number (Include area code)

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

Month

Day

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/Province of

 

driver license

Driver License Number

Sex

M F

o o

Height

 

 

Eye Color

 

 

 

 

FEET

INCHES

 

 

 

 

 

 

Client ID number as it appears on your NYS Vehicle Escort card (if available)

 

Address Where You Get Your Mail (Include Street Number and Name, Rural Delivery, and/or Box)

 

 

 

 

Apt. #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City or Town

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

Zip Code

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address Where You Live - If different from your mailing address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Include Street Number and Name, Rural Delivery, and/or Box)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apt. #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City or Town

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

Zip Code

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address Change for:

 

oMailing Address

oLegal Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name Change: Print your former name exactly as it appears on your escort certificate

 

 

Does any of the information

 

 

 

 

on your Escort Certificate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

have to be changed?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

oYes oNo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Change: What is the change and the reason for it ( wrong date of birth, etc.)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I state that the information I have given on this application is true to the best of my knowledge. I certify that I am the holder of a valid driver license that is not now suspended or revoked, and that I have not lost my privilege to drive in New York State.

SIGN HERE ___________________________________________________________

(Sign name in full - A married woman must use her own first name.)

DMV USE ONLY

Expiration

Proof Submitted:

Approved

 

Date

 

By

 

 

oDriver License/ID

 

 

Fee

Office

Date: