Odometer Mileage Statement

Odometer mileage statement.

IMPORTANT: Federal regulations require this statement to be given to purchasers on sales of vehicles. An inaccurate or untrue statement may make you liable for damages to the buyer and there may also be civil or criminal penalties.

Enter the name of the SELLER of the vehicle, state that the odometer described below now reads Enter the number of miles/kilometers on odometer Odometer reads.

Certify one of the following-- please "XXX" the appropriate line before the correct statement:

___________ I (we) certify that to the best of my (our) knowledge the odometer reading as stated above reflects the actual mileage of the vehicle described below.

___________ I (we) certify that to the best of my (our) knowledge the odometer reading as stated above reflects the amount of mileage in excess of designed mechanical limits of 99,999 Odometer reads of the vehicle described below.

___________ I (we) certify that to the best of my (our) knowledge the odometer reading as stated above is NOT the actual mileage of the vehicle described below, and should not be relied upon.

MAKE: Enter make of automobile

MODEL Enter model of automobile

BODY TYPE Enter body type

YEAR: Enter year of make

VEHICLE IDENTIFICATION NUMBER: Enter vehicle identification number

Certify one of the following-- please "XXX" the appropriate line before the correct statement:

__________ I (we) certify that the odometer of the vehicle described above was not altered, set back, or disconnected while in my (our) possession, and I (we) have no knowledge of anyone else doing so.

__________ I (we) certify that the odometer was alerted for repair or replacement purposes while in my (our) possession, and that the mileage registered on the repaired or replaced odometer is identical to that before such service.

__________ I (we) certify that if the repaired or replacement odometer was incapable of registering the same mileage, that it was reset to zero, and that the mileage on the original odometer

or the odometer before repair was __________________ Odometer reads.

SELLER (Transferor) address:

Enter SELLER's street address

Enter SELLER's city, state- zip code

Date of statement: ___________________________

___________________________________________________

Enter the name of the SELLER of the vehicle

BUYER (Transferee) name and address:

Enter BUYER's name

Enter BUYER's street address

Enter BUYER's city, state- zip code

Receipt of copy acknowledged:

____________________________________________

Enter BUYER's name

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