Fillable LETTER OF AUTHORIZATION (Department of Motor Vehicles )

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LETTER OF AUTHORIZATION (Department of Motor Vehicles )

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Occupational and Business Licensing
555 Wright Way
Carson City, NV 89711
(775) 684-4690
www.dmvnv.com
LETTER OF AUTHORIZATION
Please print or type
Business Name: _________________________________________ Business License Number: ________________
Address: _________________________________________________________________________________________
City State Zip Code: ________________________________________________________________________________
Telephone Number: (_______)______________________________
Please check appropriate authorization boxes:
All Activities Pick Up Licenses Pick Up Plates/Decals
Pick Up Supplies Pick Up Titles Sign Forms
Sign Renewal Form Sign Titles
_________________________________________________________________________________________________
Printed Name of Authorized Agent Signature
_________________________________________________________________________________________________
Printed Name of Authorized Agent Signature
_________________________________________________________________________________________________
Printed Name of Authorized Agent Signature
_________________________________________________________________________________________________
Printed Name of Authorized Agent Signature
The listed Agent(s) is no longer authorized to represent my business:
____________________________ _____________________________ _______________________________
Printed Name of Agent Printed Name of Agent Printed Name of Agent
____________________________ ______________________________ _______________________________
Printed Name of Agent Printed Name of Agent Printed Name of Agent
I hereby authorize the changes as indicated above for my business with the Nevada Department of Motor Vehicles.
_____________________________________________________
Printed Name of Principal
_____________________________________________________ ____________________________
Signature of Principal Date
To protect your business, notify the Department immediately of any changes to the above information.
OBL276 (7/2009)
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LETTER OF AUTHORIZATION (Department of Motor Vehicles )

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Completed 24 December 2020

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