Free odometer disclosure statement 18
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TENNESSEE DEPARTMENT OF REVENUE
ODOMETER DISCLOSURE STATEMENT

FEDERAL and STATE LAW requires that you 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.
I,
SELLER OR TRANSFEROR’S NAME (PLEASE PRINT)
certify to the best of my knowledge that the odometer reading on the vehicle described below is the actual mileage of the
vehicle unless one of the following statements is checked:

ODOMETER READING (NO TENTHS)
1

I hereby certify that the mileage st ated is in excess of the mechanical limits of the odometer.

2

The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY.

MAKE

MODEL

BODY TYPE

VEHICLE IDENTIFICATION NUMBER

SELLER OR TRANSFEROR’S ADDRESS

YEAR

CITY

STATE

ZIP CODE

X
SELLER OR TRANSFEROR’S SIGNATURE

DATE OF THIS STATEMENT

BUYER OR TRANSFEREE’S NAME (PLEASE PRINT)

BUYER OR TRANSFEREE’S ADDRESS

X
BUYER OR TRANSFEREE’S SIGNATURE

CITY

STATE

Z