Print Form MINNESOTA DEPARTMENT OF PUBLIC SAFETY DRIVER AND VEHICLE SERVICES 445 Minnesota Street Saint Paul, MN 55101-5187 Phone: (651) 297-2126 Web: dvs.dps.mn.gov Ce rt i fi c a t i o n C h ec k lis t - Off- Highway Mo torcycle This form is to be used by the owner of an off-highway motorcycle, registered with the Minnesota Department of Natural Resources, to certify that said motorcycle has been converted to meet the requirements for use on public roads and highways. The PS2000 form must accompany this document. The following is a non-inclusive list of requirements that must be met: LIGHTING q At least one and not more than two headlamps, which comply with the requirements and limitations of M.S., sections 169.47 to 169.79 q Rear Lamps n At least one tail lamp, exhibiting a red light plainly visible from a distance of 500 feet to the rear. n Such rear lamp or separate lamp must illuminate with a white light the rear registration plate so it can be read from a distance of 50 feet to the rear. q Reflectors that comply with M.S. 169.50, Subd. 3. q At least one stop lamp meeting the requirements of M.S. 169.57, Subd. 1. REARWARD VISION q At least one rear view mirror attached and adjusted so as to reflect to the operator a view of the roadway for a distance of at least 200 feet to the rear of the motorcycle. WARNING DEVICES q At least one horn which is audible at a distance of at least 200 feet under normal conditions. TIRES q Tires in compliance with M.S. 169 SEATING q Any motorcycle with a seat designed or suited for use by a passenger shall be equipped with footrests for the passenger. NOISE COMPLIANCE q A muffler that complies with M.S. 169.69 n Must comply with noise rules adopted by the Pollution Control Agency for motor vehicles pursuant to section M.S. 169.693. Vehicle Identification Information Vehicle Identification Number: DNR Registration/License Number: Year: Make: Model: DNR Registration Expiration Date*: *Current registration with Minn. DNR must be maintained for registration with Minn. Driver and Vehicle Services to be valid. X Owner(s) Signature Date X Owner(s) Printed Name(s) References: Minnesota Statutes 169 and 84.788 and Federal Regulation 41 CFR 571 PS30399-01 12/11