STATE OF ALASKA

DIVISION OF MOTOR VEHICLES

POWER OF ATTORNEY

I do hereby appoint as my attorney-in-fact

(Printed Name)

(Printed Name)

to sign any and all documents relating to title and registration for the following vehicle:

Serial # (VIN) Year Make

This form must be completed in full (in ink) and must be surrendered with the Application for Title and
Registration (812) or the Vehicle Transaction Application (821). Only the ORIGINAL, notarized
document is acceptable.

/ / 20
Signature Date ADL or Other ID Number

Subscribed And Sworn To Before Me This day of , 20 (SEAL)

Month Year

Notary or Alaska DMV Representative (AMVC & Office Location) My Commission Expires

Form 847 (Rev. 02/2012) Alaska.gov/dmv