Odometer Reading Correction Affidavit

Date: County/State:

Vehicle Owner Name: Address: City/State/ZIP:

Vehicle Information: Year: Make: Model: VIN (Vehicle Identification Number): License Plate Number:

Odometer Information: Current (Incorrect) Odometer Reading: Correct Odometer Reading:

Reason for Correction:

Details/Explanation:

Affirmation:

I, the undersigned, certify that the above statements are true and correct to the best of my knowledge and that I am the lawful owner of the above-described vehicle. I understand that making a false affidavit is a criminal offense.

Owner Signature: Date:

Notary Public: Subscribed and sworn before me on this date: Notary Public Signature: My commission expires: