TENNESSEE DEPARTMENT OF REVENUE
Odometer Disclosure Statement
RV-F1317001 (Rev. 6-20)
PURPOSE: Federal and state law require both seller (transferor) and buyer (transferee) to accurately state the
mileage of any used motor vehicle, with a manufacture year less than ten (10) years, in connection with the
transfer of ownership whether sale, trade-in or exchange. Failure to complete or providing a false statement may
result in fines and/or imprisonment.
INSTRUCTIONS: In Section A, the seller (transferor) prints their name on the line and checks one box that best
applies. In Section B, the seller (transferor) and/or buyer (transferee) complete the required information, including
the date of transaction.
SECTION A:
I,
1. Actual Mileage of the vehicle, no discrepancies
ODOMETER READING
2.
In Excess of Mechanical Limits: I hereby certify that the mileage stated is in excess of the mechanical limits
of the odometer (check only if digits on odometer are impossible to determine).
3.
Not Actual Mileage - odometer reading is not the actual mileage. WARNING - Odometer Discrepancy
form must be completed, or titling transaction will be delayed.
EXEMPTIONS, as defined by NHTSA (National Highway Traffic Safety Administration), "a transfer of any of
the following motor vehicles need not disclose the vehicle's odometer mileage under the following circumstances:
a)
b)
d)
e)
New vehicle prior to first transfer for purposes other than resale
c)
(NO TENTHS)
Gross Vehicle Weight Rating of more than 16,000 pounds
Vehicle not self-propelled
Vehicle is 10 or more years old
Vehicle sold directly by the manufacturer to any agency of the United States in conformity with
contractual specifications
SELLER OR TRANSFEROR'S NAME (PLEASE PRINT)
Certify to the best of my knowledge that the odometer reading on the vehicle described below is one of the
following statements (check one):
Year:
VIN:
Make:
Model:
City:
Date:
Seller Address:
State: Zip:
State:
Zip:
SECTION B:
Seller Signature:
Buyer Address: City:
Buyer Name
(Print):_________________________________ Buyer Signature:_______________________________
Date:_____________
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