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Get FL HSMV 86064 2015-2021

Failure to do so may result in suspension of your driving privileges. UNDER PENALTIES OF PERJURY I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE. FURTHER I AGREE TO DEFEND THE TITLE AGAINST ALL CLAIMS. SIGNATURE OF APPLICANT OWNER PRINTED NAME OF APPLICANT OWNER DATE HSMV 86064 Rev. 08/15. STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES AFFIDAVIT FOR GOLF CART MODIFIED TO A LOW SPEED VEHICLE Florida Assigned FLA VIN The undersigned hereby certifies that the golf cart modified to a low speed vehicle conforms to Federal Regulations under Title CFR Part 571. 500 and 316. 2126 Florida Statutes including but not limited to the following Headlamps Stop lamps Tail lamps Rear license plate bracket with either a tail lamp or a separate lamp constructed and placed to illuminate with a white light the rear registration plate and render it clearly legible from a distance of 50 feet to the rear Front and rear turn signal lamps Windshield with an AS1 or AS4 composition Type 1 or Type 2 seat belt assembly conforming to section 571. 209 of this part Federal Motor Vehicle Safety Standard No* 209 Seat belt assemblies at each designated seating position An exterior mirror mounted on the driver s side of the vehicle and either an exterior mirror mounted on the passenger s side of the vehicle or an interior mirror Parking Brakes Reflex reflectors one red on each side as far to the rear as practicable and one red on the rear Windshield cleaning device pursuant to 316. 2952 3 4 Florida Statutes Horn pursuant to 316. 271 1 Florida Statutes Slow Moving Vehicle Emblem SMV pursuant to 316. 2225 7 a b Florida Statutes Top speed is greater than 20 MPH but not greater than 25 MPH pursuant to 320. 01 42 Florida Statutes it can be gasoline or electrical/battery powered Requirement of a weight slip The Gross Vehicle Weight Rating cannot exceed 3 000 lbs. The GVWR includes the net weight of the vehicle plus the rated cargo load plus 150 lbs. times the number of seating positions equipped with seat belts Notice Section 320. 02 5 a Florida Statutes requires all low speed vehicles registered in Florida to provide and maintain Personal Injury Protection and Property Damage insurance on the vehicle. STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES AFFIDAVIT FOR GOLF CART MODIFIED TO A LOW SPEED VEHICLE Florida Assigned FLA VIN The undersigned hereby certifies that the golf cart modified to a low speed vehicle conforms to Federal Regulations under Title CFR Part 571. 500 and 316. 2126 Florida Statutes including but not limited to the following Headlamps Stop lamps Tail lamps Rear license plate bracket with either a tail lamp or a separate lamp constructed and placed to illuminate with a white light the rear registration plate and render it clearly legible from a distance of 50 feet to the rear Front and rear turn signal lamps Windshield with an AS1 or AS4 composition Type 1 or Type 2 seat belt assembly conforming to section 571..

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