Free odometer disclosure statement 12
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ODOMETER AND DAMAGE DISCLOSURE STATEMENT

Odometer Disclosure Statement
Enter odometer reading exactly as it appears on the
vehicle’s odometer (excluding tenths) and check applicable boxes.
The vehicle described below is equipped with an odometer that (please check
one):
ODOMETER READING

(NO

TENTHS)



has five digits, excluding tenths



has six digits, excluding tenths

 1. I certify that, to the best of my knowledge, this odometer reading reflects the ACTUAL MILEAGE as
seen on the odometer of the vehicle described below.

 2. I certify that, to the best of my knowledge, this odometer reading “EXCEEDS MECHANICAL LIMITS.”
(Odometer started over at zero)

 3. I certify that, to the best of my knowledge, this odometer reading is “NOT THE ACTUAL MILEAGE.
WARNING - ODOMETER DISCREPANCY.”

Damage Disclosure Statement - Check One Box
Making a false statement or failing to accurately disclose the salvage status of a vehicle may subject
you to substantial civil fines in addition to a