Fillable ODOMETER DISCLOSURE STATEMENT (Honda Financial Services)

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ODOMETER DISCLOSURE STATEMENT (Honda Financial Services)

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ODOMETER DISCLOSURE STATEMENT
FE
DERAL LAW (AND STATE LAW, IF APPLICABLE) REQUIRES THAT THE LESSEE DISCLOSE THE
MILEAGE TO THE LESSOR IN CONNECTION WITH THE TRANSFER OF OWNERSHIP. FAILURE TO
COMPLETE OR MAKING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.
COMPLETE THE DISCLOSURE FORM BELOW AND RETURN TO LESSOR.
I, _________________________________________________, ST
ATE THAT THE ODOMETER NOW READS
___________________________ (NO TENTHS) MILES AND I HEREBY CERTIFY THAT TO THE BEST OF
MY KNOWLEDGE: (check one)
(1) THE ODOMETER READING REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE DESCRIBED
BELOW.
(2) THE ODOMETER READING REFLECTS THE AMOUNT OF MILEAGE IN EXCESS OF ITS
MECHANICAL LIMITS.
(3) THE ODOMETER READING IS NOT THE ACTUAL MILEAGE. WARNING – ODOMETER
DISCREPANCY.
YEAR
MAKE
MODEL
BODY
VEHICLE IDENTIFICATION NO.
LESSEE INFORMATION
Co-Les
see’s Name:
Addr
ess:
City, State, ZIP:
Lessee’s Signature
Date of Statement
LESSOR INFORMATION
Honda Lease Trust or HVT, Inc. or HVT, Inc., Trustee for Honda Lease Trust
1919 Torrance Blvd.
Torrance, CA 90501
Date Form Sent to Lessee
Date Completed Form Received from Lessee
Lessor’s Signature
Honda Lease Trust or HVT, Inc. or HVT, Inc., Trustee for Honda Lease Trust
Honda Financial Services is a DBA of American Honda Finance Corporation
Odom_Disc_Title_Release_Info
Honda Financial Services, P.O. Box 70252, Philadelphia, PA 19176
TITLE RELEASE INFORMATION
Customer Name: ______________________________________________________________
Co-Lessee Name: _____________________________________________________________
Account Number: _____________________________________________________________
Year Make and Model: _________________________________________________________
VIN: ________________________________________________________________________
Please complete this form to indicate where the Certificate of Title should be sent. If the title
should be sent directly to your Financial Institution, please enter their information in the fields
provided.
Mailing Address for Certificate of Title:
Financial Institution (if applicable): ___________________________________________
Name (if applicable): ______________________________________________________
Street Address: ___________________________________________________________
City, State, and Zip Code: __________________________________________________
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ODOMETER DISCLOSURE STATEMENT (Honda Financial Services)

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Completed 15 January 2021

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