Date: ___________________
An owner or officer of a corporation must sign this letter of authorization.
Under penalty of perjury, I attest that I am authorized to sign this letter of authorization.
Customer Signature:
Printed Name:
Title:
Company Name:
(If applicable)
Address:
Telephone Number:
AUTHORIZATION TO COMPLETE BLANK CHECK AMOUNT
I, _____________________________ (business name if not an individual) authorize a deputy of the
Harris County Tax Office to write in the exact dollar amount of payment due on the check I have provided
for the motor vehicle transaction(s) submitted. All other fields, including the PAY TO THE ORDER OF
(payee) must
be comp
leted.
I
understand that this is a convenience service provided by
the Harris County
Tax Office (Tax Office) and
hold the Tax Office harmless from liability. This authorization letter will be retained by the Tax Office
and will remain in effect until authorization is withdrawn in writing.
UNDER NO CIRCUMSTANCE WILL A CHECK WITH A BLANK PAYEE BE ACCEPTED.
MV‐503 www.hctax.net Rev.11/13
Tax Assessor-Collector & Voter Registrar
ANN HARRIS BENNETT
click to sign
signature
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