Free odometer disclosure statement 31
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ODOMETER DISCLOSURE STATEMENT
FEDERAL LAW (AND STATE LAW, IF APPLICABLE) REQUIRES THAT THE LESSEE DISCLOSE THE
MILEAGE TO THE LESSOR IN CONNECTION WITH THE TRANSFER OF OWNERSHIP. FAILURE TO
COMPLETE OR MAKING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.
COMPLETE THE DISCLOSURE FORM BELOW AND RETURN TO LESSOR.
I,

, STATE THAT THE ODOMETER NOW READS
(NO TENTHS) MILES AND I HEREBY CERTIFY THAT TO THE BEST OF

MY KNOWLEDGE: (check one)
(1) THE ODOMETER READING REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE
DESCRIBED BELOW.
(2) THE ODOMETER READING REFLECTS THE AMOUNT OF MILEAGE IN EXCESS OF ITS
MECHANICAL LIMITS.
(3) THE ODOMETER READING IS NOT THE ACTUAL MILEAGE. WARNING – ODOMETER
DISCREPANCY.
YEAR

MAKE

MODEL

BODY

VEHICLE IDENTIFICATION NO.

LESSEE INFORMATION
Lessee’s Name:
Co-Lessee’s Name: Address:
City, State, ZIP:
Account Number:

Lessee’s Signature

Date of Statement

LESSOR INFORMATION
Honda Lease Trust or HVT, Inc. or HVT, Inc., Trustee for Honda Lease Trust
20800