Odometer Disclosure Statement - Government of New Jersey
Odometer Disclosure Statement
Information
1. FEDERAL LAW requires that you state the mileage upon transfer of ownership. Failure to complete this
disclosure statement or providing false information may result in fines and/or imprisonment.
2. Any person who knowingly or willfully misrepresents the description of a vehicle or makes a false statement in
any title papers, forges, changes or counterfeits a part of title papers, or uses title papers on or for the wrong
motor vehicle is subject to civil, criminal and administrative penalties.
3. This odometer disclosure statement is only a supplement to a fully assigned Certificate of Title.
Step 1 ? Vehicle Information
Vehicle Identification Number
Body Type
Year
Make
Model
Step 2 ? Buyer Information
Buyer/MVC Entity Name
Owner Driver License Number/MVC Business Entity Identification Number
Buyer Address
City/Town
State
Zip Code
Step 3 ? Seller Information
Seller Name
Date of Sale
Seller Address
City/Town
State
Zip Code
Date of Odometer Statement
Step 4 ? Odometer Information I/We certify that the odometer reading on the vehicle described above is _________________________ (don't show tenths) and to the best of my/our knowledge this number reflects the actual mileage of the vehicle unless one of the following statements is checked:
I/We hereby certify that to the best of my/our knowledge the odometer has exceeded its mechanical limit and the reading started again at 0.
WARNING ? ODOMETER DISCREPANCY ? I/We hereby certify that the odometer reading is NOT the actual mileage and should not be relied upon for accuracy.
Step 5 ? Statement of Buyer I/We the undersigned, hereby certify that the motor vehicle described above and on the attached certificate of ownership was purchased by me/us and I/we have compared the vehicle identification number shown on this certificate with that of the motor vehicle purchased and found that they agree in every particular.
Note: N.J.S.A. 39:10-11 requires that the attached certificate, after assignment, be presented to the Motor Vehicle Commission within 10 days. Failure to do so will result in a penalty of $25, which will be an addition to the filing fee for a new certificate of ownership. Step 6 ? Signature
__________________________________________________ Seller's Signature
______________________________ Date
__________________________________________________
Buyer's Signature
Motor Vehicle Commission Use Only Clerk Initials: Transaction Number:
______________________________ Date
OS/SS-2 (R1/19)
Visit us at New Jersey is an Equal Opportunity Employer
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