4. ODOMETER DISCLOSURE STATEMENT
Federal law requires that you state the mileage upon transfer of ownership. Failure to complete
this or providing a false statement may result in fines and/or imprisonment.
I / We, ___________________________ (Seller), state that the odometer reading shown
above (see Pg. 1) is true and correct to the best of my knowledge, and that it reflects the actual
mileage of the vehicle described above, unless one of the following statements is checked:
☐ - I hereby certify that to the best of my knowledge the odometer reading reflects the
amount of mileage in excess of its mechanical limits.
☐ - I hereby certify that the odometer reading is not the actual mileage.
5. SIGNATURES
IN WITNESS THEREOF, on _______________________ (mm/dd/yyyy) , the Buyer and Seller
acknowledge that the Motor Vehicle is being sold without any representations ("as-is") and that
after the sale the Seller shall not have any liability other than the details in this Bill of Sale.
Buyer Signature: Printed Name:
Buyer Signature: Printed Name:
Seller Signature: Printed Name:
Seller Signature: Printed Name:
Witness Signature 1: Printed Name:
Witness Signature 2: Printed Name: