Free odometer disclosure statement 39Free odometer disclosure statement 39
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STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
2900 Apalachee Parkway
NEIL KIRKMAN BUILDING, TALLAHASSEE, FLORIDA 32399-0610

SEPARATE ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT
VEHICLE DESCRIPTION
Vehicle Identification Number

Year

Make

Color

Body

Title Number

ODOMETER DISCLOSURE STATEMENT
WARNING: Federal and State law requires that you state the mileage in connection with an application for a
Certificate of Title. Failure to complete or providing a false statement may result in fines and/or imprisonment.
WE STATE THAT THIS5
DATE READ

/

,

or 6 DIGIT ODOMETER NOWS READS
/

.XX (NO TENTHS) MILES,

, AND WE HEREBY CERTIFY THAT TO THE BEST OF OUR KNOWLEDGE THE

ODOMETER READING:
CAUTION:
Read carefully before
checking a box.

1. REFLECTS ACTUAL MILAGE.
2.

IS IN EXCESS OF ITS MECHANICAL LIMITS.(EXCESS OF ITS MECHANICAL LIMITS APPLIES TO 5 DIGIT ODOMETERS)

3. IS NOT THE ACTUAL MILEAGE. WARNING – ODOMETER DISCREPANCY
UNDER PENALT