Free odometer disclosure statement 22
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New Jersey
Motor Vehicle Commission

P.O. Box 017
Trenton, NJ 08666-0017

STATE OF NEW JERSEY
1-609-292-6500

Odometer Disclosure Statement
I/We hereby assign and warrant Certificate of Ownership of the vehicle described on the attached Certificate of Ownership.
I/We further certify the accuracy of the mileage as specified below.
VEHICLE DESCRIPTION

Year:

Make:

VIN:
BUYER NAME

(Print)

Model:

Body Type

Dr. License:
Corpcode #

Buyers Address:
SELLER NAME

(Print)

Seller Address
Date of sale
NOTE FEDERAL LAW requires that you state the mileage upon transfer of ownership. Failure to complete this disclosure
statement or providing false information may result in fines and/or imprisonment.
I/We state that the odometer now reads
(do not show tenths) and to the best of my/our knowledge
that reflect the actual mileage of the vehicle described on the attached certificate of ownership, unless one of the following
statements is checked.
_____ (1) I/We hereby certify that to the best of my