South Carolina Department of Motor Vehicles
AFFIDAVIT FOR PERSON 64 YEARS OF AGE OR OLDER
4027-A
(Rev. 6/10)
Persons 64 years of age, the fee for a private passenger (excluding trucks) vehicle is $22.00.
Persons 65 years of age or older are eligible for license fees as follows:
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Private passenger car registration: $20.00
Property carrying vehicles of 6,000 lbs. or less: $30.00
Personalized plate passenger car registration: $50.00
Personalized plate property carrying vehicles of 6,000 lbs. or less: $60.00
NOTE: THIS AFFIDAVIT CAN ONLY BE SUBMITTED IF YOU DO NOT HAVE A SOUTH CAROLINA
DRIVER’S LICENSE (DL), BEGINNER’S PERMIT (BP) OR IDENTIFICATION CARD (ID). IF YOU DO HAVE
A SOUTH CAROLINA DL, BP OR ID, YOU MUST SUBMIT PROPER DOCUMENTATION REQUIRED TO
CHANGE YOUR DATE OF BIRTH ON YOUR SC DL, BP OR ID.
If your tax bill/renewal notice indicates the fees shown above, it is not necessary to complete this form.
If not, please complete this affidavit and present it to the Department of Motor Vehicles with your
application for renewal registration.
I certify that I am 64 years of age or older.
Date of Birth: ___________________________
___________________________________________________________________________________
Full Name
___________________________________________________________________________________
Signature
Date
___________________________________________________________________________________
Driver License Number, ID Number or Social Security Number
License Plate Number
NOTE: Section 56-3-390 of the South Carolina Code of Laws, 1976, provides:
Any person who
(a) fraudulently uses or gives a false or fictitious name or address in any
application required to be made under this chapter except for registration,
(b) knowingly makes a false statement in any such application, or
(c) knowingly conceals a material fact in any such application shall be guilty of a
misdemeanor and shall upon conviction be punished as herein provided. Any
person who shall operate a vehicle or any owner who shall permit the
operation or movement of any vehicle registered and licensed under a
violation of this section shall be guilty of a misdemeanor and, upon
conviction, shall be punished as herein provided.