Form Mv2012 - Low-Speed Vehicle Affidavit
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1SD EForm - 2018
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LOW-SPEED VEHICLE AFFIDAVIT
(Attach to Title and Registration Application)
“Low-speed vehicle,” a 4-wheeled vehicle whose speed attainable in 1 mile is more than 20
miles per hour and not more than 25 miles per hour on a paved level surface. The
manufacturer’s certificate of origin or title must clearly identify the vehicle as a low-speed
vehicle.
I, the undersigned, do hereby swear that the vehicle described herein is a low-speed vehicle, as
identified by the manufacturer’s statement/certificate of origin or certificate of title (form not
required if SD title denotes low-speed vehicle) and that the vehicle is equipped with the following
accessories:
Year:______ Make:____________________________ Model:___________________________
Serial Number:_____________________________ Title Number:_______________________
Name (print or type): ____________________________________________________________
Address: ______________________________________________________________________
This low-speed vehicle is equipped with the following accessories (check all that apply, not to be
exclusive):
Headlights
Turn Signals (front & rear)
Tail Lamps
Stop Lamps
Parking Brake
Conforming VIN
Conforming Windshield
Seat Belts (each seating position, type 1 or 2 Conforming Seat Belt Assembly)
Red Reflex Reflectors (one on each side to the far rear, and one on rear)
Exterior Mirror(s) (exterior mirror passenger’s side or interior mirror and exterior
driver’s side mirror)
Speed attainable in one mile is more than 20 mph and not more than 25 mph on paved
level surface
(Note: local governments may adopt more stringent local ordinances governing low-speed vehicle
operation)
I further swear that the above described vehicle is insured pursuant to SDCL 32-35-113. I also
declare and affirm under the penalties of perjury that this affidavit has been examined by me and to
the best of my knowledge and belief is in all things true and correct.
Signature/Date:_________________________________________________________________
Signed and sworn to before me this ____ day of _______________________________, 20 _____
______________________________________________________________________________
Notary Signature
My Commission expires on the ______ day of ________________________________, 20_____
Anyone operating a low-speed vehicle must possess a valid driver’s license.
MV2012 7/08
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