Mississippi Department of Revenue - Motor Vehicle Forms · Mississippi state form

Form 78-011 Power of Attorney for Insurance Company to Transfer Total Loss Vehicle

Form 78-011 appoints an attorney-in-fact to handle ownership transfer, title, or registration for a described total loss vehicle on the owner’s behalf.

What this form is

Use Form 78-011 to appoint an attorney-in-fact to transfer ownership, apply for title, or apply for registration for a described vehicle. The form includes spaces for owner signatures, vehicle details, and insurance company information. It also contains a notary section. Electronic signatures are permitted only for insurance company submissions to the Mississippi Department of Revenue related to a total loss vehicle; notarization is not required for those electronic signatures.

Who needs it

Vehicle owners appointing an attorney-in-fact for a total loss vehicle transfer, title application, or registration application may use this form.

Why it needs a notary

Owner signatures must be notarized, and this can be done online with a commissioned online notary. The form waives notarization for qualifying electronic insurance company submissions.

How to submit it

The form lists Motor Vehicle Services, P.O. Box 1383, Jackson, MS 39215-1383. It permits electronic signatures only for qualifying insurance company submissions to the Mississippi Department of Revenue.