Free odometer disclosure statement 15
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ODOMETER DISCLOSURE STATEMENT

BOTH FEDERAL LAW AND STATE LAW REQUIRE THAT YOU (THE TRANSFEROR) STATE THE MILEAGE IN
CONNECTION WITH THE TRANSFER OF OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE
STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.
STATE THAT THE ODOMETER NOW READS
(NO TENTHS)
I,
MILES AND TO THE BEST OF MY KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THEVEHICLE
DESCRIBED BELOW, UNLESS ONE OF THE FOLLOWING STATEMENTS ISCHECKED:
(1) I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING
REFLECTS THE AMOUNT OF MILEAGE OF THE VEHICLE IN EXCESS OF THE
ODOMETER'S MECHANICAL LIMITS.
(2) I HEREBY CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL MILEAGE.
WARNING - ODOMETER DISCREPANCY

MODEL

MAKE

BODY TYPE

VEHICLE IDENTIFICATION
NUMBER

YEAR

TRANSFEROR'S SIGNATURE

PRINTED NAME

TRANSFEROR'S ADDRESS
STREET

CITY OR TOWN

STATE

ZIP CODE

DATE OF STATEMENT

TRANSFEREE'S SIGNATURE

PRINTED NAME

TRANSFEREE'S NAME - ENTER NAME AS IT APPEARS ON THE AS