Federal Odometer Mileage Disclosure Form
Vehicle Information
Year
Make
Model
Vehicle Identification Number (VIN)
Odometer Reading
Odometer Reading (No tenths)
This is the actual mileage unless one of the following statements is checked:
Mileage in excess of its mechanical limits
Not the actual mileage (Warning: Odometer Discrepancy)
Seller Information
Seller's Name (Printed)
Seller's Address
Seller's Signature
Date
Buyer Information
Buyer's Name (Printed)
Buyer's Address
Buyer's Signature
Date