Kansas Department of Revenue
Odometer Disclosure Statement
www.ksrevenue.gov
I,
Title Number State Title Issued
Check the Appropriate Box
Original odometer disclosure statement for vehicle
Correction to odometer disclosure statement
Odometer statement for transfer of vehicle without title (legal affidavit or court document)
Federal and State law requires that you state the mileage upon transfer of ownership. Failure to
complete or providing a false statement may result in fines and/or imprisonment.
Transferor’s printed name
certify that the odometer now reads miles To the best of my knowledge, the
mileage is:
Check the Appropriate Box
Actual mileage
In excess of its mechanical limits
Not the actual mileage (Warning, odometer discrepancy)
Vehicle Information:
Year Make Model Body Style
Vehicle Identification Number
Transferor’s Signature Date
Transferor’s Hand Printed Name
Transferor’s Address
Transferee’s Signature Date
Transferee’s Hand Printed Name
Transferee’s Address
Instructions
Attach original to title.
The seller and buyer will each get a copy.
TR-59 (Rev. 12/15)
