Odometer Disclosure Statement
For Export/Import Vehicles
Vehicle Make
Model
Year
Vehicle Identification Number (VIN)
Body Type
Color
Odometer Reading (no tenths)
Date of Reading
Check one:
The mileage stated is the actual mileage of the vehicle.
The mileage stated is in excess of its mechanical limits.
The odometer reading is not the actual mileage.
Remarks
Seller Information
Name (Printed)
Address
Signature
Date
Buyer Information
Name (Printed)
Address
Signature
Date