Nebraska Motor Vehicle Power Of Attorney Motor Carrier Services

Information you will need

• Attorney in Fact Name
• Attorney in Fact City
• Attorney in Fact State
• Attorney in Fact ZIP Code
• Attorney in Fact Email Address
• Attorney in Fact Phone Number
• Licensee Name
• Licensee Street Address
• Licensee City
• Licensee State
• Licensee ZIP Code
• IRP/IFTA Carrier Number
• Business Name
• Licensee Mailing Address
• Mailing Address City
• Mailing Address State
• Mailing Address ZIP Code
• Other Acts
• Signing Date
• Authorize Acts
• Attorney in Fact Street Address
• Motor Vehicles Matter of Representation
• Attorney in Fact Title or Firm Name
• Time Period

…and 3 more fields in the PDF.

Completed by the licensee.