Make: _____________ Model: _____________ Body-Type: _____________
Year: _____________ Color: _____________ Odometer: _____________ Miles
Vehicle Identification Number (VIN): __________________________ (17 Characters)
Taxes. All municipal, county, and State taxes in relation to the purchase of the motor
vehicle, including sales taxes, is ☐ included ☐ not included in the purchase price.
Other Terms & Conditions: ______________________________________________
______________________________________________________________________
Odometer Disclosure Statement
FEDERAL and STATE LAW requires that you state the mileage in connection with the
transfer of ownership. Failure to complete or providing a false statement may result in
fines and/or imprisonment.
I/We, __________________________ certify to the best of my knowledge that the
odometer reading of _____________ Miles.
The actual mileage of the vehicle is accurate, unless one (1) of the following statements
is checked:
☐ - I hereby certify that 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.
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 ___________________ Print Name ___________________
Buyer Signature ___________________ Print Name ___________________