Federal Odometer Disclosure Statement - eForms
ODOMETER DISCLOSURE STATEMENT
Federal 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, ______________________ (SELLER'S NAME, PRINT) state that the odometer now
reads ______________________ miles (NO TENTHS) 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 DISCREPANCY
MAKE ______________ BODY STYLE ______________ YEAR ______________
MODEL ______________ VIN ______________________________________
LAST PLATE STATE ______________ LAST PLATE NUMBER ______________
SELLER'S SIGNATURE _________________ SELLER'S NAME _________________
SELLER'S ADDRESS ___________________________________________________
CITY _________________ STATE _________________ ZIP CODE _______________
ACKNOWLEDGING MILEAGE READING AS CERTIFIED
BUYER'S SIGNATURE _________________ BUYER'S NAME _________________
BUYER'S ADDRESS ___________________________________________________
CITY _________________ STATE _________________ ZIP CODE _______________
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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