Sd Eform 0862 - South Dakota Uniform Damage Disclosure Statement
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1SD EForm - 0862
V3
Complete and use the button at the end to print for mailing.
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SOUTH DAKOTA UNIFORM DAMAGE DISCLOSURE STATEMENT
STATE LAW REQUIRES THAT UPON THE SALE, TRANSFER, OR TRADE-IN OF A MOTOR VEHICLE, THE PERSON WHO SELLS, TRANSFERS
OR TRADES THE VEHICLE MUST PROVIDE A COMPLETED VEHICLE DAMAGE DISCLOSURE STATEMENT TO THE PERSON TO WHOM THE
VEHICLE IS TRANSFERRED. IF A MOTOR VEHICLE WHICH IS TITLED IN ANOTHER JURISDICTION IS TO BE TITLED IN SOUTH DAKOTA, THE
PERSON WHO REGISTERS THE VEHICLE (IMPORTER) MUST COMPLETE A DAMAGE DISCLOSURE STATEMENT. ANY PERSON WHO, WHEN
REQUIRED TO DO SO, FAILS TO COMPLETE OR FALSIFIES THIS DISCLOSURE IS GUILTY OF A CLASS 1 MISDEMEANOR. DISCLOSURE
STATEMENTS ARE REQUIRED IF THE VEHICLE BEING TRANSFERRED IS LESS THAN SEVEN (7) YEARS OLD AND WEIGHS LESS THAN
16,000 POUNDS GVWR.
VEHICLE INFORMATION: YEAR: ________ MAKE: __________________________________ MODEL: ___________________________________
SERIAL NO.: _________________________________________ TITLE STATE: ________TITLE NO.: ______________________________________
DAMAGE: COSTS NECESSARY TO RETURN THE DAMAGED VEHICLE TO ITS PREDAMAGED CONDITION-INCLUDES PARTS, LABOR, PAINT
AND FRAMEWORK DONE ON THE DAMAGED VEHICLE.
1. VEHICLE SUSTAINED DAMAGE IN EXCESS OF $5,000.00 IN ANY SINGLE OCCURRENCE WHILE I HAVE OWNED THIS VEHICLE?
____YES ____NO
2. AT THE TIME I ACQUIRED THIS VEHICLE, THE VEHICLE HAD UNREPAIRED DAMAGE IN EXCESS OF $5,000.00?
____YES ____NO
IF YOU CHECKED “YES” TO EITHER OF THESE QUESTIONS, THEN CHECK BELOW ALL CAUSE (S) OF VEHICLE DAMAGE WHICH APPLY:
____ COLLISION ____ FIRE ____ VANDALISM ____ WEATHER ____ SUBMERSION IN WATER
CIRCLE DAMAGED AREA OF
VEHICLE ON DIAGRAM BELOW:
____ OTHER DAMAGES (LIST) _______________________________________________________________
I/WE, AS THE SELLER/IMPORTER, DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY
THAT THIS INFORMATION HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY KNOWLEDGE
AND BELIEF, IS IN ALL THINGS TRUE AND CORRECT.
________________________________________________________________________________________________
PRINTED NAME OF SELLER/IMPORTER
________________________________________________________________________________________________
SIGNATURE OF SELLER/IMPORTER
(DATE OF SALE)
DMV-610 07-03
1.
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CLEAR FORM
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