Instructions for Completing the Odometer Disclosure Statement

Instructions for Completing the Odometer Disclosure Statement

? The form must be filled out completely and accurately. ? Do not alter this form - no corrections or cross-outs. Do not use white-out. ? Do not print double-sided. ? If you need to make a correction, please download a new form at:

? See arrows below for important details.

Enter lessee's name. Printed name and

signature must match lease statement. Check ONLY one box.

Enter lessee's name as it appears in the line above.

Do not write in or sign this section.

Enter current mileage of the vehicle. Do not include tenths of a mile.

(For example: 47000.2 should be entered as 47000)

Accurately enter vehicle Year, Make, Model and VIN details. Check appropriate Body Type box.

Lessee's signature must match names printed above.

The directions contained herein are intended to help reduce clerical errors and do not constitute

legal advice from JPMorgan Chase Bank, N.A. If you have a question regarding how to complete the

form you should consult with your own legal counsel.

(24-029-A) 3/24

Please complete, sign, and submit the form via email at title.management@. Or Fax: 1-877-501-7620 Or mail: Chase Auto, 700 Kansas Lane, Mail-Code LA4-4042, Monroe, LA 71203.

ODOMETER DISCLOSURE STATEMENT (LEASED VEHICLES)

When returning or purchasing your leased vehicle, please complete, sign and return disclosure form below to JPMorgan Chase Bank, N.A.

FEDERAL LAW (AND STATE LAW, IF APPLICABLE) REQUIRES THAT THE LESSEE DISCLOSE THE MILEAGE TO THE LESSOR IN CONNECTION WITH THE TRANSFER OF OWNERSHIP. FAILURE TO COMPLETE OR MAKING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.

I ________________________________________ (print name of person making disclosure), hereby certify that the odometer

now reads

(no tenths) miles.

Please check only one box.

1. I hereby certify that, to the best of my knowledge, the above-listed odometer reading reflects the actual mileage of the vehicle described below.

2. I hereby certify that, to the best of my knowledge, the above-listed odometer reading reflects the amount of mileage in excess of its mechanical limits.

3. I hereby certify that the above-listed odometer reading is not the actual mileage. Warning - Odometer Discrepancy.

Year

Make

Model

Vehicle Identification Number (VIN)

Body Type (select one):

Convertible

Coupe

Sedan

SUV

Truck Other

Lessee: Please complete this form and return it with the payoff check for title release. Note if any part of the odometer statement is illegible, unsigned, undated or incomplete the title will not be released.

Lessee's Name and Address Information:

Lessee Name: Lessee Address:

CITY

STATE

ZIP

Lessee's Signature: _______________________________________________________________ Date of Statement: _______________________________________________________________

DO NOT WRITE BELOW THIS LINE

Lessor's Name: J_P_M__o_rg_a_n__C_h_a_s_e__B_a_n_k_, _N_.A__. _____________________________________________________________ Lessor's Address: C_h_a_s_e__A_u_to_,_7_0_0__K_a_n_s_a_s_L_a_n_e_,_M__a_il_C__o_d_e_L_A_4_-_4_0_4_2_,_M_o_n_r_o_e_,_L_A__7_1_2_0_3_________________________

Date Disclosure Form sent to Lessee: _________________________________________________________________________________________ Date Completed Disclosure Form Received from Lessee: _________________________________________________________________________ Lessor's Signature: _______________________________________________________________________________________________________

Name and Title: ______________________________________________________________________________________________

Version 7.B (24-029-C) 3/24

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download