Federal Odometer Disclosure Statement



ODOMETER DISCLOSURE STATEMENTFederal and State law require 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, FORMTEXT [SELLER'S FIRST & LAST NAME], state that the odometer now reads FORMTEXT [NUMBER OF MILES] miles and to the best of my knowledge that it reflects the actual mileage of the vehicle described below, unless one of the following statements is checked. ? - (1) I hereby certify that the odometer reading reflects the amount of mileage in excess of its mechanical limits? - (2) I hereby certify that the odometer reading is not the actual mileage. WARNING – ODOMETER DISCREPANCYMAKE FORMTEXT [MAKE] BODY STYLE FORMTEXT [BODY STYLE] YEAR FORMTEXT [YEAR OF VEHICLE]MODEL FORMTEXT [MODEL] VIN FORMTEXT [VEHICLE IDENTIFICATION NUMBER]LAST PLATE STATE FORMTEXT [STATE] LAST PLATE NUMBER FORMTEXT [LICENSE PLATE NUMBER]SELLER’S SIGNATURE _________________ SELLER’S NAME FORMTEXT [SELLER FIRST & LAST NAME]SELLER’S ADDRESS FORMTEXT [SELLER ADDRESS]CITY FORMTEXT [CITY] STATE FORMTEXT [STATE] ZIP CODE FORMTEXT [ZIP CODE]ACKNOWLEDGING MILEAGE READING AS CERTIFIEDBUYER’S SIGNATURE _________________ BUYER’S NAME FORMTEXT [BUYER FIRST & LAST NAME]BUYER’S ADDRESS FORMTEXT [BUYER ADDRESS]CITY FORMTEXT [CITY] STATE FORMTEXT [STATE] ZIP CODE FORMTEXT [ZIP CODE]DATE OF CERTIFICATION FORMTEXT [DATE OF CERTIFICATION]The provisions of this disclosure statement section shall not apply to the following transfers: (1) A vehicle having a gross vehicle weight rating of more than 16,000 pounds; (2) A vehicle that is not self-propelled; (3) A vehicle that is 10 years old or older; or (4) A new vehicle prior to its first transfer for purposes other than resale. (5) A new vehicle sold directly by the manufacturer to any agency of the United States in conformity with contractual specifications. ................
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