Authorization to Drive a Motor Vehicle - DOC - DOC by WorkSession

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									                        Authorization to Drive a Motor Vehicle


Vehicle Owner (Owner)
Name: ______________________________
Address: ____________________________
         ____________________________
Home phone: ____________________             Work phone: ____________________
Cell phone or pager: ____________________           Email: ____________________
Vehicle
Make, model, and year of vehicle: _______________
Vehicle license plate number: _______________
State of registration: _______________ Vehicle registration number: _______________
Insurance company: _______________
Insurance policy number: _______________
Person Authorized to Drive (Borrower)
Name: _______________
Address: ____________________________
         ____________________________
Home phone: ____________________             Work phone: ____________________
Cell phone or pager: ____________________           Email: ____________________
Driver's license number: _________________
Motor vehicle insurance company (if any): _______________
Insurance policy number (if any): _______________


                        Authorization and Consent of Vehicle Owner
I am the lawful owner of the vehicle indicated above. I give my authorization and consent for
Borrower to use this vehicle as follows:
Dates of use: _______________
Area in which vehicle may be used: _______________
Any restrictions or conditions on use: ________________________________________


I declare under penalty of perjury under the laws of the state of _____________ that the
foregoing is true and correct.
Owner's signature: _____________________________________________
Date: _______________

								
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