Odometer Disclosure Statement - Fremont County Government
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1ODOMETER DISCLOSURE STATEMENT
Effective April 29, 1989, the federal Truth in Mileage Act of 1986 (Public Law 99-579) requires an Odometer Disclosure Statement which must be
executed by both the seller and the buyer.
FEDERAL AND STATE REGULATIONS REQUIRE you to state the mileage upon transfer of
ownership of a motor vehicle. Failure to complete or providing a false statement may result in fines
and/or imprisonment.
VEHICLE INFORMATION
Year_____ Make ________________ Vehicle Identification Number (VIN)______________________
ACKNOWLEDGMENT OF ODOMETER DISCLOSURE BY SELLER
I, ______________________________________________, hereby state that the odometer now
reads ___________(No Tenths) miles and to the best of my knowledge, it reflects the statement
checked below:
the actual mileage of the vehicle, or
the amount of mileage in excess of mechanical limits;
the odometer reading is NOT the actual mileage. WARNING: ODOMETER DISCREPANCY
or
SIGNATURE
OF SELLER_______________________________________________________________________
PRINT NAME
OF SELLER___________________________________ DATE OF STATEMENT_______________
NOTE: If titled in a firm’s
name, print the firm’s name.__________________________________________________________
Street
Address_____________________________________City/State/ZIP__________________________
ACKNOWLEDGMENT OF ODOMETER DISCLOSURE BY BUYER
SIGNATURE
OF BUYER_______________________________________________________________________
PRINT NAME
OF BUYER_______________________________________ DATE OF STATEMENT____________
NOTE: If purchased by a
firm, print the firm’s name.____________________________________________________________
Street
Address______________________________________City/State/ZIP_________________________
FC9-10
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