Kansas Department of Revenue Odometer Disclosure …
Kansas Department of Revenue
Odometer Disclosure Statement
Title Number
State Title Issued
Check the Appropriate Box
Original odometer disclosure statement for vehicle Correction to odometer disclosure statement Odometer statement for transfer of vehicle without title (legal affidavit or court document)
Federal and State law requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment.
I,
certify that the odometer now reads mileage is:
Transferor's printed name
miles To the best of my knowledge, the
Check the Appropriate Box
Actual mileage In excess of its mechanical limits Not the actual mileage (Warning, odometer discrepancy)
Vehicle Information:
Year
Make
Model
Body Style
Vehicle Identification Number
Transferor's Signature
Date
Transferor's Hand Printed Name
Transferor's Address
Transferee's Signature
Date
Transferee's Hand Printed Name
Transferee's Address
Instructions Attach original to title. The seller and buyer will each get a copy.
TR-59 (Rev. 12/15)
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