Dealership Odometer Declaration Form
Vehicle Information
Year
Make
Model
VIN
Body Type
Color
Odometer Information
Current Odometer Reading
The odometer reading exceeds the mechanical limits
The odometer reading is not the actual mileage
Seller (Dealership) Information
Dealer Name
Dealer Address
City
State
ZIP
Buyer Information
Buyer Name
Buyer Address
City
State
ZIP
Signatures
Seller (Dealership) Signature
Date
Buyer Signature
Date