Bill of Sale and Odometer Disclosure Statement
Department of Motor Vehicles
Agency of Transportation
120 State Street
Montpelier, Vermont 05603-0001
If the vehicle being sold is 9 years old or newer and you are not submitting a separate Odometer Disclosure Statement,
please complete the Odometer Disclosure Statement on back of this form.
I / We (Seller(s) (If a company, give company name)
hereby sell, assign or transfer
ownership of the vehicle or
vessel described below
Vehicle/Vessel Identification Number (VIN/HIN)
Odometer Reading (Vehicles only, no tenths)
Has this vehicle failed an emissions test and been granted a time extension waiver in the past 12 months?
NOTE: A vehicle may not have two (2) consecutive time extension waivers. See avip.vermont.gov for more information.
If Vehicle is Salvage, Salvage and Rebuilt or Totaled this Section Must be Completed:
I/We certify the motor vehicle described above is: Salvage Salvage and Rebuilt Declared a total loss by insurer
Any person who sells trades or offers for sale or trade any interest in a salvaged, salvaged and rebuilt or totaled vehicle shall disc
lose the fact that the vehicle has been salvaged
and rebuilt or totaled to a prospective purchaser both orally and in writing before a sale, trade or transfer is made. Writte
n disclosure that the vehicle has been salvaged,
salvaged and rebuilt or totaled, in addition to being disclosed on the certificate of title as required by this subchapter, shall also be conspicuously disclo
transfer, purchase or other agreement.
Failure of the seller to provide the notices required by this secti
on shall result in the seller being required, at the option of the buyer, to refund to the buyer the purchase price,
including taxes, license fees and similar governmental charges. This information has been conveyed to the purchaser, both orally and in wri
ting in accordance with 23 V.S.A.
Sections 2093 (b) (c), Salvaged, totaled and rebuilt vehicles. If this section is completed at least one new owner must sign:
The vehicle/vessel is free of all liens and encumbrances. Statements and warrants made herein are certified under penalty of
23 V.S.A. Sections 202, 203, 2082 & 3829 (4). If vehicle is jointly owned, both owners must sign.
Seller Signature - if company, Authorized Representative (include title)
Seller #1: Seller #2:
Buyer Signature - if company, Authorized Representative (include title)
Buyer #1: Buyer #2: