Free odometer disclosure statement 44
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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.
I,

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
limits.
(2) I hereby certify that the odometer reading is not the actual mileage.
Warning: Odometer Discrepancy
Make

Model

Vehicle Identification Number

Body Type
Year

Dealer Stock
Number

Transferor's Signature (Seller)

X
(Printed Name)
Transferor's Street Address (Seller)
City

State

ZIP Code

Date of Statement

Transferee's Signature (Buyer)

X
(Printed Name)
Transferee's Street Address (Buyer)
City

State

ZIP Code