Odometer Fraud Declaration Form
Vehicle Information
Make
Model
Year
VIN
Odometer Reading
Current Owner’s Information
Full Name
Address
Declaration
I/we hereby declare that the odometer reading stated above reflects the actual mileage of the vehicle described. I/we affirm that, to the best of my/our knowledge, the odometer has not been altered or tampered with, except as noted below.
If any known odometer discrepancies or adjustments, please describe below:
Owner’s Signature
Date