Leased Vehicle Odometer Disclosure Notice and Statement - Chrysler Capital

[Pages:1]Leased Vehicle Odometer Disclosure Notice and Statement

FEDERAL LAW (AND STATE LAW, IF APPLICABLE) REQUIRES THAT YOU (THE LESSEE) STATE THE MILEAGE UPON TRANSFER OF OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT. Please complete the disclosure form below and return it to Chrysler Capital.

I, ________________ (print name of person making disclosure) state that the odometer now reads

_________________ (no tenths) miles, and (please check one box):

I hereby certify that, to the best of my knowledge, it reflects the actual mileage of the vehicle described below; or

I hereby certify that, to the best of my knowledge, the odometer reading reflects the amount of mileage in excess of its mechanical limits; or

I hereby certify that the odometer reading is NOT the actual mileage.

WARNING - ODOMETER DISCREPANCY.

VIN (Vehicle Identification Number) Year

Make

Model

Body Type

Lessee Name Lessee Address:

Street

City PLEASE SIGN HERE

State

ZIP Code

Date of Statement

Lessee Signature

FOR CHRYSLER CAPITAL USE ONLY

Lessor Name and Address: Chrysler Capital P.O. Box 961275 Fort Worth, TX 76161-1275

Lessor Signature: Date Disclosure Form Sent to Lessee:

Date Completed Disclosure Form Received by Lessee:

P.O. Box 961275, Fort Worth, TX 76161-1275 ? ? 855.563.5635

?2022 Santander Consumer USA Inc. All rights reserved. Chrysler Capital is a registered trademark of FCA US LLC and licensed to Santander Consumer USA Inc. Lease agreements are owned by CCAP Auto Lease Ltd. and serviced by Chrysler Capital. All other trademarks are the property of their respective owners. CCAP-315250-CUST_042222

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