ODOMETER DISCLOSURE STATEMENT - Ohio

OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES

ODOMETER DISCLOSURE STATEMENT

Federal law (and State law), if applicable) 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,

state that the odometer (of the vehicle described below) now

PRINT TRANSFEROR'S NAME

reads

(no tenths) 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 to the best of my knowledge 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 TYPE

MODEL

VEHICLE ID NUMBER

YEAR

TRANSFEROR'S PRINTED NAME (SELLER)

TRANSFEROR'S STREET ADDRESS

CITY

STATE

DATE OF STATEMENT

TRANSFEROR'S SIGNATURE (SELLER)

X

PRINTED NAME OF TRANSFEROR

ZIP CODE

TRANSFEREE'S PRINTED NAME (BUYER)

TRANSFEREE'S STREET ADDRESS

CITY

STATE

ZIP CODE

TRANSFEREE'S SIGNATURE (BUYER)

X

RECEIPT OF COPY ACKNOWLEDGED

PRINTED NAME OF TRANSFEREE

bmv.

BMV 3724 4/17 [17601081]

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