I, (sellers printed name) hereby state that the Odometer now reads
(no tenths) miles, and the best of my knowledge that it reflects the actual miles, UNLESS one
of the items below is checked:
STATE OF ARKANSAS VEHICLE BILL OF SALE/ODOMETER DISCLOSURE STATEMENT
Section 1 - Vehicle Identification Number (VIN)
Section 2 - Buyer Information
Section 3 - Company Information
Section 4 - Dealer/Seller Name and Address
2. WARNING - ODOMETER DISCREPANCY -I hereby certify that the odometer reading is not the actual mileage.
1. EXCEEDS MECHANICAL LIMITS - I hereby certify that to the best of my knowledge the odometer reading
reflects the amount of mileage in excess of its mechanical limits.
If buyer is a company rather than individuals, go directly to Section 3 - Company Name.
Check this box if there are multiple owners
Section 8 - Sales Price Information - Signatures
Full Sales Price of Vehicle
Section 5 - Purchase Date
Section 6 - Description of Vehicle Purchased and Vehicle Trade-In
Secondary Color (If applicable)
Vehicle Identification Number of Trade-In
Section 7 - Odometer Disclosure
WARNING: It is a FELONY for any taxpayer to willfully attempt to evade or defeat the payment of any tax, penalty, or interest due under state
law; OR for any person to willfully assist a taxpayer in evading or defeating the payment of any tax, penalty, or interest due under state law.
This form may be reproduced so long as the format and language are not changed from the original.
