Form Vp-249 - Affidavit Of Acknowledgement For A Power Of Attorney
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1555 WRIGHT WAY
CARSON CITY, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada (877) 368-7828
AFFIDAVIT OF ACKNOWLEDGEMENT FOR A POWER OF ATTORNEY
Nevada Revised Statute Chapter 13 allows a third party the right to demand that an agent provide an
acknowledgement stating a power of attorney is a true copy and to the best of the agent’s knowledge,
the principal is alive and the relevant powers of the agent have not been altered or terminated.
The affiant completing this affidavit must be the agent of the power of attorney.
This affidavit is for acknowledgement only and must accompany all other required documents
including a power of attorney.
Please print or type
I,____________________________________________________________ declare, as the agent for
Name of Agent on POA
_______________________________________________________ that the power of attorney I am
Name of Principal on POA
submitting is a true copy and to the best of my knowledge, the principal is alive and the relevant
powers granted to me by the named principal have not been altered or terminated.
Vehicle Identification Number ________________________________________________________
Affiant’s Printed Full Legal Name ______________________________________________________
Nevada Driver’s License, Identification Card
Number, Date of Birth, or FEIN (Business only) ___________________________________________
Physical Address
_______________________________________________________________________________
City
State
Zip Code
Mailing Address
_________________________________________________________________________________
City
State
Zip Code
I declare under penalty of perjury that the foregoing is true and correct.
State of Nevada, County of __________________
Signed and sworn to before me on ____________
Date
By ______________________________
Signature of Affiant
______________________________________________
Notary Public or Authorized Nevada DMV Representative
VP-249 (8/2012)
Signatures must be originals. Photocopies are not acceptable.
Changes may not be made to this form once it is signed and witnessed.
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