Federal Regulations require you to state the mileage upon
transfer of ownership of a motor
vehicle. Failure to complete or providing a false statement
may result in fines and/or
imprisonment.
I, _________________________________________ herby
state that the odometer (Print name of person
making disclosure)
now reads _____________________ (no tenths) miles and
to the best of my knowledge 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.
