Free odometer disclosure statement 06
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STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
www.flhsmv.gov/offices/

SEPARATE ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT
VEHICLE DESCRIPTION
Vehicle Identification Number

Year

Make

Color

Body

Title Number

ODOMETER DISCLOSURE STATEMENT
WARNING: Federal and State law requires that you state the mileage in connection with an application for a
Certificate of Title. Failure to complete or providing a false statement may result in fines and/or imprisonment.
WE STATE THAT THIS

5

or

,

6 DIGIT ODOMETER NOW READS

.XX (NO TENTHS) MILES,

DATE READ ________/_______/________, AND WE HEREBY CERTIFY THAT TO THE BEST OF OUR KNOWLEDGE THE
ODOMETER READING:
CAUTION:
Read carefully before
checking a box.

1. REFLECTS ACTUAL MILEAGE.
2. IS IN EXCESS OF ITS MECHANICAL LIMITS.(EXCESS OF ITS MECHANICAL LIMITS APPLIES TO 5 DIGIT ODOMETERS)
3. IS NOT THE ACTUAL MILEAGE. WARNING – ODOMETER DIS