Free Odometer Disclosure Statement (Printable PDF)

ATTENTION: You should be prepared to satisfy any insurance requirements when you transfer, register, or title your vehicle.

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Odometer Disclosure Statement Instructions

Instructions: This form will help you create a printable odometer disclosure statement form for selling a car, truck, motorcycle, or other vehicle. Simply enter the necessary information, click generate, and save a PDF or print a copy of your free odometer disclosure.

Sometimes, there will be a section on the vehicle’s title for the Odometer Disclosure Statement. Some state DMVs may provide a form to use, otherwise, you can use a generic form that meets the state and federal odometer disclosure requirements.

If you do not know the details for one of the fields below, you can leave it blank and fill it in later.

Once you generate your custom odometer disclosure form with this template, there will be a section for the buyer’s and seller’s signature.

Both the buyer and the seller should retain a signed copy for their own records. The DMV will typically require the original.

Have you created a bill of sale yet? If not, you can do that using our free bill of sale form.

ODOMETER DISCLOSURE STATEMENT

Date of Sale:

Federal and State law require 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, (SELLER) state that the odometer now reads miles/kilometers.

I hereby certify that to the best of my knowledge: (Check ONE)

(1). The odometer reading reflects the actual mileage of the vehicle.

(2). The odometer reading reflects the amount of mileage in excess of its mechanical limits.

(3). The odometer reading is not the actual mileage. WARNING – ODOMETER DISCREPANCY.

Vehicle Details

VIN: License Plate #: State:

Year: Make: Model: Body Type:

Transferor and Transferee Details

Seller’s Name:

Seller’s Address: , ,

Buyer’s Name:

Buyer’s Address: , ,

Agreement

I certify under penalty of perjury that the statements herein contained are true and correct.

Buyer Signature

Date

Seller Signature

Date

Next Steps

After completing the odometer disclosure statement template with the details of the buyer, seller, and vehicle, you should create at least 2 copies.

If you need to make changes, please click “Back”, otherwise click “Print” to save a PDF or print your Odometer Disclosure Statement.

You can edit the document sizing and print details in your system’s prompt.

Both the buyer and the seller should sign and date each of the copies.

The Odometer Disclosure Statement should be included with the Title and the Bill of Sale.

The buyer and seller will also need to fill out the title and complete the title transfer process.

If necessary, the seller must also complete and submit a Notice of Transfer and Release of Liability.

Once the paperwork has been filled out and signed and the sale is complete, the buyer will need to register and title the vehicle in their name and get a new insurance policy.

For official details, requirements, and forms, please visit your state’s DMV website.

For more information about this vehicle, you can decode the VIN using our free VIN lookup.