Fillable TS 12 TS 12.pdf (Harris County Tax Office)

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TS 12 TS 12.pdf (Harris County Tax Office)

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ANN HARRIS BENNETT
Tax Assessor-Collector & Voter Registrar
TS-12 www.hctax.net Rev 9/18 v1
Vehicle Specific Authorization Letter
Please complete this printable form online or write legibly in blue or black ink ONLY, within the lines provided.
This form will not be accepted and will be returned if it is illegible, altered or incomplete.
Purchase Registration (Please Circle) Title Transfer Transaction
Vehicle driven with Expired Registration – Yes or No
Ticket/Citation issued - Yes or No
Replacement Plate or Replacement Sticker Duplicate Receipt
All of the above
Change address to: _____________________________________________________________________________
Other: _______________________________________________________________________________________
Customer, Dealer, or Company Appointing Motor Vehicle Title Service
Name:
Dealer #: (If any)
Phone:
( )
Address:
City:
State:
Zip Code:
Name:
Dealer #: (If any)
Phone:
( )
Address:
City:
State:
Zip Code:
Year:
Make:
Body Style:
Vehicle Identification Number:
Signature of Authorized Person and/or Registered Owner
Date
Printed Name same as Signature
Phone Number
Copy of owner’s valid Personal Identification (Follow TxDMV Identification Guidelines). If registered owner and/or seller of the
vehicle is in a company and/or an automobile dealer name please attach business card, along with copy of valid Personal
Identification (Follow TxDMV Identification Guidelines). NOTE: Transportation Code 520.057 RECORDS…Requires a copy of the
customer’s driver license be maintained in the title service records which differs from the TxDMV Identification Guidelines. A Power
of Attorney may not be used to sign this form.
I, We, _ ______________________________________________ do hereby authorize the following Title Service
(Enter as listed on DBA): _______________________________________ Phone: (______) _________________
to complete the transaction(s) indicated below.
Please initial or check one or more:
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TS 12 TS 12.pdf (Harris County Tax Office)

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Completed 20 July 2020

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