SD EForm - 2222
V1
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SOUTH DAKOTA ELECTRONIC LIEN AND TITLE NONPARTICIPATING LENDER REQUEST FOR PAPER TITLE
This request for paper certificate of title is to be completed by a lender who does not participate in
the Electronic Lien and Title (ELT) Program. Such Lender must currently appear as the lienholder on
the DMV’s record for the vehicle identified below and must be the requestor for a paper copy of a
South Dakota certificate of title to be printed. Upon completion of this form, the lender shall mail it to
the South Dakota Division of Motor Vehicles.
Vehicle Owner: __________________________________________________________________________________
(must match owner identified on DMV records)
Vehicle Identification Number (VIN): ______________________________________________________________
Title No.: ___________________________ Vehicle Year: _______ Vehicle Make: _________________________
Name of Entity and Address where printed South Dakota Certificate of Title is to be mailed:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________
Reason for requesting a paper certificate of title:
____ Moving to Another State -- Title Required to Register Vehicle in New State of Residence
____ Insurance Claim/Total Loss
____ Court Order
____ Name: Change, Addition or Deletion of Owner
____ Other (MUST BE APPROVED BY DMV): _________________________________________________________
State Reason
Name of Lender: _________________________________________________________________________________
(must match lender identified as lienholder on DMV records)
On behalf of the above identified lender, I am authorizing the South Dakota Division of Motor
Vehicles to print and mail the requested certificate of title as directed above.
Signature: _______________________________________________ Title: ___________________________________
Date: __________________________________ Telephone Number: _____________________________________
Mail Completed Application:
For Department Use Only
Division of Motor Vehicles
___ Approved
445 East Capitol Avenue
___ Denied
Pierre SD 57501-3185
Reason: ______________________________________________
or Fax to: 605-773-2550
Date: _________ By: _______________________________________
PRINT FOR MAILING
CLEAR FORM
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