Odometer Disclosure Statement Template printable pdf download

Odometer Disclosure Statement Template

ODOMETER DISCLOSURE STATEMENT

State and Federal Law requires that an odometer statement be completed on most vehicle title

transactions. The current Ohio Certificate of Title has the necessary statement on the reverse side of the

title. The older yellow (gold) title require a separate federal odometer statement which can be obtained

from any title office.

DO NOT fill out the assignment on the reverse side of the Certificate of Title until an actual sale has

been made. Make certain that you know the proper name and address of the buyer before making the

assignment. You as the seller, are required to state the actual purchase price and the odometer reading

of the vehicle. You must sign the title exactly as the title was issued to you and your signature must be

notarized. When sale is to an individual, make a copy of the completed, notarized assignment for your

personal record of date of sale/transfer.

TO BE COMPLETED BY THE SELLER

I/We _____________________________________ state that the odometer mileage indicated for the

vehicle described below is:

______________________ (check one) ___ Miles ___ Kilometers ___ Hours

and I hereby certify to the best of my knowledge that (check one statement below that is applicable)

____ (1) The odometer reading is the actual mileage.

____ (2) The odometer reading reflects the amount of mileage in excess of its mechanical limits.

____ (3) The odometer reading is not actual mileage. WARNING - ODOMETER DISCREPANCY.

Year:

Make:

Body Type:

Model:

Vehicle Identification Number:

Printed Name of Seller:

Address of Seller:

Odometer Disclosure Statement Template