Form HSMV 86064 PDF Details

In the realm of transportation and vehicle modification within the State of Florida, the Department of Highway Safety and Motor Vehicles provides a crucial framework through the Hsmv 86064 form for individuals wishing to transform their golf carts into low-speed vehicles, a growing trend that blends leisure with practical urban mobility. This affidavit serves as a testament to the vehicle's adherence to a comprehensive list of safety standards and federal regulations, encompassing everything from lighting requirements—headlamps, stop lamps, and tail lamps—to the specifics of seat belt assemblies and windshield specifications. Furthermore, the form meticulously outlines the necessity for parking brakes, reflex reflectors, a windshield cleaning device, and even the inclusion of a horn, alongside the imposition of a slow-moving vehicle emblem to ensure visibility and safety on the road. Significantly, it addresses the legal stipulations around the vehicle's top speed capabilities, insurance requirements to safeguard against personal injury and property damage, and the importance of a weight slip to certify the vehicle's gross weight rating. By requiring the signatures of the vehicle owner(s) under the penalties of perjury, the form underscores the legal seriousness and the responsibilities entrained in converting a golf cart into a low-speed vehicle, ensuring that such modifications meet the statutory and safety criteria set forth by both federal and state authorities.

QuestionAnswer
Form Name Form HSMV 86064
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names hsmv 86064 form, florida cart speed vehicle, florida speed vehicle, florida low speed

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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. 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)

SIGNATURE OF APPLICANT (CO-OWNER)

_______________________________

__________________________________

PRINTED NAME OF APPLICANT (OWNER)

PRINTED NAME OF APPLICANT (CO-OWNER)

DATE: ________________________________

DATE: __________________________________

HSMV 86064 (Rev. 08/15)

 

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