Free odometer disclosure statement 05
Download the document to the computer for easy use
There are more pages to preview,Read on

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
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 –
MAKE ______________ BODY STYLE ______________ YEAR ______________
MODEL ______________ VIN ______________________________________
LAST PLATE STATE ______________ LAST PLATE NUMBER ______________
SELLER’S SIGNATURE _________________ SELLER’S NAME _________________
SELLER’S ADDRESS ___________