Free odometer disclosure statement 08
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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 providing a false statement may result in fines and/or imprisonment.
I,

certify that, to the best of my knowledge, this odometer
(SELLER’S PRINTED NAME)
reading is
. (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)

YEAR

MAKE

BODY

DATE OF STATEMENT

BUYER’S NAME
(PRINTED NAME)
(STREET)
(CITY)

(STATE)

(ZIP CODE)

(STATE)

(ZIP CODE)

BUYER’S SIGNATURE X
(SIGNATURE)

SELLER’S NAME
(PRINTED NAME)
(STREET)
(CITY)
SELLER’S SIGNATURE X
(SIGNATURE)