This seems to have come from a rehearsal session before the Rolling Thunder tour, with Dylan pounding on a honky-tonk piano. It also has a knock-out version of "If you see her...." I hope the whole session will eventually surface.
Dylan has never performed Sad Eyed Lady Of The Lowlands live before an audience. This is a studio recording of it done for inclusion in the film, Renaldo & Clara. This version is still a rarity though and, I agree, rather wonderful