Division of Motor Vehicle Licensing
Federal Law 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
(Transferor's name, Print)
miles and, to the best of my knowledge 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.
Vehicle Identification Number
Date of Statement