Sd Eform 2019 V1 - Request For 30-Day Title Delivery Extension
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SD EForm - 2019
V1
HELP
REQUEST FOR 30-DAY TITLE DELIVERY EXTENSION
A request is being made within 40 days of the date of sale for an extension of the delivery of title to our retail
customer for the below referenced vehicle. This extension is requested because the lienholder on the title has
failed to release the lien or deliver the title document to our dealership. A copy of the lien release payoff
verifying that payment has been made to the lienholder and the date the payoff was made must be
attached.
Vehicle Description and Sale Information:
Year: _______ Make: ________________________________ Model: _________________________________
SD Title #: ________________________ Serial #: ________________________________________________
Date of Sale: __________
Purchaser’s Name: __________________________________________________________________________
Address: __________________________________________________________________________________
Telephone #: ______________
Lienholder Information (please provide as much information as possible so we can assist you in resolving
this problem):
Lienholder Name: __________________________________________________________________________
Address: __________________________________________________________________________________
Telephone # & Contact Person: ________________________________________________________________
Other Information:
Dealership Information:
Name and Dealer #: _________________________________________________________________________
Address: __________________________________________________________________________________
Telephone # & Contact Person: ________________________________________________________________
Dealer Signature/Date: _______________________________________________________________________
Dealer/Authorized Representative Signature
Date
__________________________________________________________________________________________
For Office Use:
___approved ___denied DMV:___________________________________________________________
Authorized Representative Signature
Date
FAX FORM TO: DMV, ATTN: DEALER LICENSING, 605-773-2549
MV:2011 7/08
PRINT FOR MAILING
CLEAR FORM
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