Odometer Disclosure Statement Form – All 50 States

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Updated June 06, 2022

An odometer disclosure statement is a required attachment to a Vehicle Bill of Sale at the time of purchase for all vehicles below 16,000 pounds and under 10 years of age. The document is required by federal law in all 50 States to be filed in order for the finalization of the sale and allows the buyer of the vehicle to apply for registration (along with the title and bill of sale and any other required forms).

This is the federal form although your State may have its own Odometer Disclosure Statement that is provided by the Department of Motor Vehicles (DMV).

Federal Law – 49 U.S. Code Chapter 327 (Odometers)

Odometer Disclosures – By State

(Video) What is an Odometer Disclosure Statement?

How to Write

1 –  Access The Necessary Form

You may Open or Download this form as an Adobe PDF, Open Document Format (.odt), or Microsoft Word (.docx)

2 – Document The Seller’s Identity

On the first blank space of this document’s statement, enter the Full Name of the Vehicle’s Seller

3 – Define The Odometer Reading

The second blank space requires the Number of Miles, rounded to the nearest tenth, displayed on the Vehicle’s Odometer to be documented.

Next, the Seller must define the accuracy of the Odometer. There will be two selections provided below the introductory statement for this purpose.

If the Odometer is accurate and represents the actual mileage the vehicle has driven then place a mark on the first checkbox.

If the Odometer Reading does not display the actual number of miles driven by the vehicle then mark the checkbox for choice “(2).”

4 – Provide Vehicle Information

The next portion of this form will consist of several blank lines, each calling for some defining information commonly used to identify a Vehicle. To start, report the Make, Body Style, and Year of the Vehicle in the appropriate areas.

On the next line, report the Vehicle Model then, the Vehicle Identification Number (VIN).

Finally, enter the State where the Vehicle had its last License Plate issued on the blank space labeled “Last Plate State.” Then, report the last License Plate Number attached to the Vehicle in the space labeled “Last Plate Number.”

5 – Verify Through Party Signatures

This form will require that both the Seller and the Buyer Sign this document and provide some basic information. Two separate sections have been provided for this purpose. First, locate the words “Seller’s Signature.”

The individual selling the vehicle and reporting the Odometer information on this form must sign then print his or her name on the blank spaces labeled “Seller’s Signature” and “Seller’s Name” (respectively).

The blank line below the signature line, “Seller’s Address,” must have the Seller’s Physical Street Address recorded (Building Number, Street, and any applicable Suite Number).

The next line will have three blank spaces. Utilize these spaces to enter the “City,” “State,” and “Zip Code” associated with the Seller’s Street Address reported.

The next portion of this form will require attention from the Buyer of the Vehicle. This portion should only be filled out once the Buyer has viewed the Odometer reading and reviewed this document. Once this task is completed the Buyer must sign his or her Name on the “Buyer’s Signature” line. Adjacent to this, on the space designated as “Buyer’s Name,” the Buyer’s Printed Name must be clearly displayed.

Below the Buyer’s Signature and Printed Name, his or her Street Address must be entered on the blank line following the words “Buyer’s Address.”

Next, the City, State, and Zip Code attached to the Buyer’s Address must be reported on the blank spaces labeled “City,” “State,” and “Zip Code.”

Finally, the Date this document has been signed by both parties must be recorded on the blank line labeled “Date of Certification.”

Once this form has been completed, attach it to the Bill of Sale. This may not be required for every paperwork, however, such an action is widely considered a mark of good business.