Vehicle Odometer Disclosure Statement
Vehicle Information
Make:
Model:
Year:
Body Type:
Vehicle Identification Number (VIN):
Odometer Reading
Odometer Reading (no tenths):
Date of Reading:
Check one:
The mileage stated is in excess of its mechanical limits.
The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY.
Seller Information
Seller's Name (Printed):
Seller's Address:
Buyer Information
Buyer's Name (Printed):
Buyer's Address: