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STATE OF FLORIDA
DIVISION OF MOTOR VEHICLES
BUREAU OF FIELD OPERATIONS

AFFIDAVIT FOR GOLF CART MODIFIED TO A LOW SPEED VEHICLE

Florida Assigned FLA VIN: _______________________

The undersigned hereby certifies that the modified golf cart 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
● Front and rear turn signal lamps
● Windshield with a AS1 or AS5 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
● Requirement of a weight slip