Federal Odometer Disclosure Statement

Federal Law Requirement: Federal law requires that you state the mileage in connection with the transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment.

Vehicle Information

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Year

Make

Model

VIN

Transferor (Seller) Information

Seller Name

Address

Odometer Disclosure

Odometer Reading (miles)

Date of Disclosure

I hereby certify that to the best of my knowledge the odometer reading as stated above reflects the ACTUAL mileage of the vehicle described.

I hereby certify that to the best of my knowledge the odometer reading as stated above reflects the amount of mileage IN EXCESS of its mechanical limits.

I hereby certify that to the best of my knowledge the odometer reading as stated above is NOT the actual mileage. WARNING - ODOMETER DISCREPANCY.

Seller Signature

Seller Printed Name

Transferee (Buyer) Acknowledgment

Buyer Name

Address

Buyer Acknowledgment: I acknowledge that I have received a copy of this odometer disclosure statement and that the odometer reading is as stated above.

Buyer Signature

Buyer Printed Name

Date

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🔢 Federal Odometer Disclosure Statement

Vehicle Information

Transferor (Seller) Information

Odometer Disclosure

Transferee (Buyer) Acknowledgment