The following form will be used in giving a power of attorney to an agent:
POWER OF ATTORNEY
To be filed with the Oregon
Department of Transportation
__________(Name of Carrier in full)________
___________(Place)__________(Date)_______
Form A.F. 1 No.__________
To the OREGON
DEPARTMENT OF TRANSPORTATION
Salem, Oregon
This is to certify that (name of carrier) has made, constituted and appointed and by these presents does make, constitute and appoint (name of person appointed) the true and lawful attorney and agent for the said carrier and in its name, place and stead:
_______________________________________
_______________________________________
And the said (name of carrier) does hereby give and grant unto said attorney and agent full power and authority to do and perform all and every act and thing above specified, as fully to all intents and purposes as if the same were done and performed by the said carrier, hereby ratifying and confirming all that said attorney and agent may lawfully do by virtue hereof, and assuming full responsibility for the acts and neglects of said attorney and agent hereunder.
IN WITNESS WHEREOF, the said carrier has caused these presents to be signed (in its name by its legal executive officer) at __________ in the State of Oregon, on this_____ day of __________, 19__.
__________(Name of Carrier)__________
By:
__________(Name of Officer)__________
__________(Title of Officer)__________
Attest:
(Corporate Seal)
Carrier issuing this form will file the original with the Department and will furnish duplicate to the agent to whom power of attorney is given.
Or. Admin. R. 740-050-0060
Stat. Auth.: ORS 184.616, 184.619, 823.011 & 825.232
Stats. Implemented: ORS 825.100, 825.202 & 825.224