Affidavit for Truck Tractor Converted to a Motorhome

Converting a motor home to a truck tractor requires specific criteria. Requesting those criteria by an affiant requires the execution of this affidavit.

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SOUTH DAKOTA DIVISION OF MOTOR VEHICLES 
AFFIDAVIT FOR TRUCK TRACTOR  CONVERTED TO A MOTOR HOME 	
[A PHOT	

OG RAPH SH	

OWING A FULL VIEW OF THE VEHICLE MUST ACCOMPANY 
THE APPLICA T	

ION, AFFIDAVIT, TITLE AND SUPPORTING DOCUMENTATION AND A 
WEIGHT SLIP) 
AFFI

ANT NAME(S):__________________________________________________________________ 
AD

DRESS:__________________________________________________________________________ 
VEHICLE DAT

A: YEAR ____ MAKE_________________________ TITLE #__________________ 
LI

CENSE #___________________ SERIAL #_____________________________________________ 
I (we) hereby affirm that this vehicle m eets equi

pment requirements and will not be 
used for pr ivate busin

ess use. Check all equipment that applies to this vehicle. [To qualify, must meet at least 5 of the criteria 
listed, as well as the modification requirement stated above (SDCL 32-3-65):
___ Cooking facilities 
___ Heating or

 air conditioning system separate from vehicle engine or vehicle engine 
electrical system (must be permanently installed and meet American National 
Standards Institute and National Fire Protecti on Association standards in effect on the 
date of manufacture) 
___ Self-contained

 toilet or toilet connected to a plumbing system with connection for 
external water disposal (must be permanently installed and meet American National 
Standards Institute and National Fire Protecti on Association standards in effect on the 
date of manufacture) 
___ Po

rtable water supply, including plumbing and a sink with faucet either self-
contained or with connections for an exte rnal source (must be permanently installed 
and meet American National Standards  Institute and National Fire Protection 
Association standards in effect  on the date of manufacture) 
___ Sleeping facilities 
___ Refr

igerator 
___ 110 or 115 volt system separate from the vehicle engine 

electrical system either with its own 
power supply or with a connection for an external source or a liquefied petroleum system and 
supply (must be permanently installed and meet American National Standards Institute and 
National Fire Protection Association Standards in effect on the date of manufacture) 	
PLEASE COMPLE	

TE BOTH SIDES OF FORM  Note:  To become a motor home, the truck tractor shall be modified to include a vehicular-type unit 
built on the tractor's chassis and designed primarily as temporary living quarters for recreational, 
camping, vacation, or travel use.

(Please indicate by checking) Vehicle ____will   ____will not be used to transport a 
motor vehicle, boat, or animal to a race, to urnament, show, or similar event.  If you 
have indicated yes, check the criteria below that applies (to qualify, all of the criteria 
must apply): 
____ Prize money received from participating in the activity is declared as ordinary 
income for tax purpo ses. 
____ The cost of participating in the activity is not deducted as a business expense for 
tax pur poses. 
____ There is no corporate sponsorship exceeding $2,000 in any one calendar year. 
NOTE: IF THIS VEHICLE IS BEING USED TO TOW A TRAILER, THE TRAILER 
DOES NOT QUALIFY FOR A  PERMANENT TRAILER IDENTIFICATION PLATE. THE 
TRAILER MUST DISPLAY A NONC OMMERCIAL TRAILER PLATE. 
I (we) hereby request that the Department  of Revenue and Regulation issue a motor 
home title covering this vehicle in my (our ) name(s). I (we) hereby declare and affirm 
under the penalties of perjury that this information has been examined and to the best 
of my (our) knowledge and belief is in all things true and correct.      
Signature of Affiant(s)______________________________________________________________  
STATE OF SOUTH DAKOTA        __________________________________________________ 
COUNTY OF ____________________________  Notary Public or County Treasurer 
Subscribed and Sworn to before me this 
________ day of _____________________, 20 ___ 
MV-315 04/13