HomeMy WebLinkAbout01(B) - Discussion of UTV / Golf Cart Permits Report
APPLICATION FOR SPEICAL USE VEHICLES
City Hall, 201 Ash Avenue SW
Montgomery, MN 56069
Application fee: $20.00
Date of application_________________
Proof of valid MN Driver’s license or ATV Permit where applicable
Proof of valid insurance
Applicants Information:
Full Name of Applicant:
Applicant Address:
City, State ,Zip
Applicant Phone Number:
Applicant Driver’s License Number:
Applicant’s Age – must be over 19 What, if any, physical handicap does the operator have?
Vehicle Owner’s Name:
Vehicle Owner’s Address:
City, State, Zip
Vehicle Information – mark vehicle type
Golf Cart ATV Utility Task
Vehicle (side-by-
side)
Mini-Truck
Vehicle Information
State Registration Number
Engine Make Horse Power Displacement (UTV must be less than 1,200 cc)
Vehicle Make Model Dry Weight (UTV must be at least 1,800 and less
than 2,600lbs)
VIN/Serial Number
Vehicle is equipped with:
Rearview Mirror: Slow Moving Vehicle Emblem: OEM headlights: OEM taillights
Insurance Information
Insurance Company
Policy Number and Period
Permit Agreement and Signature
As the applicant for a Special Use Vehicle Operators Permit, I agree to the following and understand that violation of
the conditions of this permit or any city or state law, rule, or code may result in the revocation of the permit or other
legal action.
1. I understand the permit allows for use of the licensed vehicle on City and County streets within the corporate
limits of the City of Montgomery and for the crossing of state highways; this permit does not allow for the
operation of the special use vehicle on state roads or highways.
2. I understand that the licensed vehicle can only be operated during daylight hours unless equipped with OEM
headlights and taillights.
3. I understand and agree that a licensed golf cart will display the slow moving vehicle emblem.
4. I will not permit the operation of the licensed vehicle by anyone under the age of 12 (MS 84.9256, subd.
1(b)(i)).
5. I will not permit the operation of a licensed ATV by any person under the age of 18 unless the operator and any
passengers are wearing approved helmet (MS 84.9256 Subd. 2)
6. I understand and agree to follow all traffic laws.
7. I understand the licensed vehicle will not carry more passengers than the vehicle is designed to carry.
Applicant Signature Date