Free odometer disclosure statement 11
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OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES

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,

, state

that the odometer (of the vehicle described below) now reads

(no tenths) miles and to the best of my knowledge that it reflects the actual
mileage of the vehicle described below, unless one of the following statements is checked.
(1) I hereby certify that to the best of my knowledge the odometer reading reflects the amount of mileage in
in excess of its mechanical limits.
(2) I hereby certify that the odometer reading is NOT the actual mileage.
WARNING - ODOMETER DISCREPANCY
MAKE

BODY TYPE

VEHICLE ID NUMBER

MODEL
YEAR

TRANSFEROR’S PRINTED NAME (SELLER) TRANSFEROR’S STREET ADDRESS

CITY
DATE OF STATEMENT

STATE
ZIP CODE
Alabama
TRANSFEROR’S SIGNATURE (SELLER)
X
PRINTED NAME OF TRANSFER