Odometer Disclosure Statement
Federal law (and State law, if applicable) requires that you state the
mileage upon 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) miles and to the best of my knowledge that
it reflects the actual mileage of the vehicle described below, unless
one of the following statements is checked.
(1) I hereby certify that to the best of my knowledge the odometer
reading reflects the amount of mileage in excess of its mechanical
(2) I hereby certify that the odometer reading is not the actual mileage.
Warning: Odometer Discrepancy
Vehicle Identification Number
Transferor's Signature (Seller)
Transferor's Street Address (Seller)
Date of Statement
Transferee's Signature (Buyer)
Transferee's Street Address (Buyer)