STATEMENT OF FACTS
TO CORRECT ERROR ON TITLE
NO ALTERATION, WHITE OUT, OR ERRORS ARE ACCEPTABLE ON THIS FORM
This is to state that an error was made on Title #
The reason for the error was:
Assignment or Odometer Reading or
It is now correct as sold to:
Federal and State laws require 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 state that the odometer now reads
(no tenths) miles as to the best of my
knowledge that it reflects the actual mileage of the vehicle described herein, unless one of the
following statements is checked:
CAUTION: DO NOT CHECK IF ACTUAL MILEAGE
I hereby certify that to the best of my knowledge 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.
WARNING - ODOMETER DISCREPANCY
Transferor’s/Seller’s Signature
Transferor’s/Seller’s Printed Name
Transferee’s/Buyer’s Signature
Transferee’s/Buyer’s Printed Name
*NOTE: This affidavit may not be acceptable when filed with jurisdictions other than Texas.
WARNING: TRANSPORTATION CODE §501.155, PROVIDES THAT
FALSIFYING INFORMATION ON ANY REQUIRED STATEMENT OR
APPLICATION IS A THIRD - DEGREE FELONY.
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