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ODOMETER DISCLOSURE STATEMENT
State Form 43230 (R3 / 5-13)
INDIANA BUREAU OF MOTOR VEHICLES

INSTRUCTIONS:

1.

2.
3.

In accordance with federal and state law, the seller of a motor vehicle must disclose the current mileage to a purchaser in
writing upon transfer of ownership. The disclosure must be signed by the seller, including the printed name. If more than one
person is a seller, only one seller is required to sign the written disclosure.
The purchaser must sign the disclosure statement, including printed name and address, and return a copy to the seller.
Complete this form in its entirety, in blue or black ink.

Federal and State law requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false
statement may result in fines, imprisonment, or both.
I,

residing at:
Printed name(s) of Seller(s)

certify to the best of my knowledge that the
Address of Seller(s) (number and street, city, state, and ZIP code)

odometer reading is the actual