ODOMETER DISCLOSURE STATEMENT
Federal law (and state law, if applicable) requires that you state the mileage upon transfer of ownership. Failure
to complete or providing a false statement may result in fines and/or imprisonment.
certify that, to the best of my knowledge, this odometer
(SELLER’S PRINTED NAME)
. (Check one):
ACTUAL MILEAGE as seen on the odometer of the vehicle described on the front of this certificate.
EXCEEDS MECHANICAL LIMITS (odometer started over at zero).
NOT THE ACTUAL MILEAGE. WARNING – ODOMETER DISCREPANCY.
VEHICLE IDENTIFICATION NUMBER (VIN)
DATE OF STATEMENT
BUYER’S SIGNATURE X
SELLER’S SIGNATURE X