MARY L. SWAIN CLERK OF COURTS POWER OF ATTORNEY TO ASSIGN TITLE (Must be signed in the presence of a Notary Public) Let it be known to all present: That I (Print name of person giving Power of Attorney) SSN: City of Address of County of Butler, Ohio, do hereby make, constitute and appoint: (Print name of person to be Power of Attorney) City of Address My true and lawful attorney for me and in my stead and behalf to do the following with the same force and effect as if same had been done by me. Check appropriate box and sign: Application for Certificate of Title __________________________________________________________ Signature of person giving Power of Attorney Application for Duplicate Title ___________________________________________________________ Signature of person giving Power of Attorney Transfer Assignment of Title ___________________________________________________________ Signature of person giving Power of Attorney Certify Mileage ________________________________ Print Name _______________________________________________ Signature of person giving Power of Attorney Actual Exceeds Non-actual Odometer reading: Warning to transferor and transferee (seller and buyer). You are required by law to state that the odometer now reads and is the actual mileage of the vehicle unless one of the previous statements is checked. Providing false information or failure to comply may result in fines and/or imprisonment. For the Purchase price of $ Year VIN/Serial Number Free of all liens Yes Model No ,. Make State of Ohio, County of Butler, SS: Sworn before me, and Subscribed in my presence this day of , 20 Notary Signature My commission expires Erasures and alterations void this document. This document void after ninety days from notarized date. American LegalNet, Inc. www.FormsWorkFlow.com