Odometer/Mileage Disclosure Statement
Please complete, sign and submit the form by Fax: 1-877-501-7620 Or mail: Chase Auto
PO Box 901069 Fort Worth, TX 76101-2069
ODOMETER DISCLOSURE STATEMENT (LEASED VEHICLES)
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.
When returning or purchasing your leased vehicle, please complete, sign and return disclosure form below to JPMorgan Chase Bank, N.A.
I ________________________________________ (print name of person making disclosure), state that the odometer now reads _____________ (no tenths) miles. I further state the following (please place a checkmark next to only one of the following statements):
I certify that, to the best of my knowledge, the above-listed odometer reading reflects the ACTUAL MILEAGE of the vehicle described below.
I certify that, to the best of my knowledge, the above-listed odometer reading reflects the amount of mileage IN EXCESS OF ITS MECHANICAL LIMITS.
I certify that the above-listed odometer reading is NOT the actual mileage.
CALIFORNIA LESSEES: I certify, under penalty of perjury under the laws of the State of California, the foregoing odometer information is true and correct.
Year
Make
Model
Vehicle Identification Number (VIN)
Body Type (select one):
Convertible
Coupe
Lessee's Name and Address Information:HICLE Lessee Name: Lessee Address:
Sedan
SUV
Truck Other
CITY
STATE
ZIP
Lessee's Signature: _______________________________________________________________ Date of Statement: _______________________________________________________________
The Odometer Disclosure Statement cannot be altered in any way. Please do not strike through any information, use white-out, or check any incorrect boxes. If any information needs to be corrected, please use a new form.
DO NOT WRITE BELOW THIS LINE
Lessor's Name: __________________________________________________________________________________________________________ Lessor's Address: ________________________________________________________________________________________________________ Date Disclosure Form sent to Lessee: _________________________________________________________________________________________ Date Completed Disclosure Form Received from Lessee: _________________________________________________________________________ Lessor's Signature: _______________________________________________________________________________________________________ Name and Title: ______________________________________________________________________________________________
Version 1.B (19-039-F) 7/19
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- vehicle return check list hyundai
- trac leasing chrysler customer version 2
- company name tax id abu sila car rental inc 473964653 acar
- santander consumer usa holdings inc reports fourth
- fourth quarter 2019
- driving growth for the remarketing professional
- wear tool web printable 1 chrysler capital
- lease program guide chrysler capital
- free cashflow to the firm new york university
- odometer mileage disclosure statement
Related searches
- financial disclosure statement student loans
- odometer disclosure statement washington
- odometer disclosure statement leased vehicle
- generic odometer disclosure statement pdf
- odometer disclosure statement pdf
- florida odometer disclosure statement form
- financial disclosure statement dept of ed
- odometer disclosure statement hyundai
- odometer disclosure statement texas
- alabama odometer disclosure statement pdf
- mortgage loan disclosure statement example
- mortgage loan disclosure statement sample