Free odometer disclosure statement 07
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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
YEAR

MAKE

VIN

BODY TYPE

MODEL

SECTION 2: TRANSFEROR/SELLER INFORMATION & STATEMENT
NAME (Please print.)
PHONE
( )

ADDRESS

I,

state that the odometer now reads

miles and to the

(Transferor/Seller’s name)

(no tenths)

best of my knowledge reflects the actual mileage of the vehicle described above unless one of the following statements
is checked.
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
SIGNATURE

DATE

SECTION 3: CERTIFICATION