49 C.F.R. § C to Part 580

Current through September 30, 2024
Appendix C to Part 580 - Separate Disclosure Form

Odometer Disclosure Statement

Federal law (and State law, if applicable) 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.

I, ____________ (transferor's name, Print) state that the odometer now reads ________ (no tenths) miles and to the best of my knowledge that it reflects the actual mileage of the vehicle described below, unless one of the following statements is checked.

-(1) I hereby certify that to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits.

-(2) I hereby certify that the odometer reading is NOT the actual mileage. WARNING-ODOMETER DISCREPANCY.

Make _______________________________

Model _______________________________

Body Type _______________________________

Vehicle Identification Number _______________________________

Year _______________________________

_______________________________

(Transferor's Signature)

_______________________________

(Printed name)

Transferor's Address _______________________________

(Street)

_______________________________

(City) (State) (ZIP Code)

Date of Statement _______________________________

_______________________________

(Transferee's Signature)

_______________________________

(Printed name)

Transferee's Name _______________________________

Transferee's Address _______________________________

(Street)

_______________________________

(City) (State) (ZIP Code)

49 C.F.R. §C to Part 580