Free odometer disclosure statement 03
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Odometer Disclosure Statement
Federal law (and State law, if applicable) requires that you state the mileage upon transfer of
ownership. Failure to complete or making a false statement may result in fines and/or
imprisonment.
I,

, state that the odometer now reads
(no tenths) miles and that to the best of my knowledge it reflects
the actual mileage of the vehicle, unless one of the following statements is checked.
 (1) The mileage stated is in excess of its mechanical limits.
 (2) The odometer reading is NOT the actual mileage. WARNING: Odometer discrepancy
exists.
Make:

Model Year:

Model:

Vehicle Identification Number (VIN):

Seller Name:
Seller Address:
Seller Signature(s):
Date of Statement:
Buyer Name:

ABC Group of America, Inc.

Buyer Address: 4800 Hamlin Road, Auburn Hills, MI 345676

Do not sign below this line
For internal use only
RECEIPT OF COPY ACKNOWLEDGED
Buyer Signature:
Buyer Printed Name:
Date of Signature:

Volkswagen Group of America, Inc.