ODOMETER DISCLOSURE STATEMENT
Instructions: Attach this form to your title and registration application documents and forward to your county clerk.
Note: Federal law requires that you state the mileage upon transfer of ownership. Failure to complete or providing a
false statement may result in fines and imprisonment under KY odometer law KRS 190.300.
SECTION 1: VEHICLE INFORMATION
SECTION 2: TRANSFEROR/SELLER INFORMATION & STATEMENT
NAME (Please print.)
state that the odometer now reads
miles and to the
best of my knowledge reflects the actual mileage of the vehicle described above unless one of the following statements
I hereby certify that to the best of my knowledge the odometer reflects mileage in excess of its mechanical limits.
I hereby certify that the odometer reading is NOT the actual mileage. WARNING ‐ODOMETER DISCREPANCY
SECTION 3: CERTIFICATION