Odometer Disclosure Statement Form – All 50 States

PDF Word ODT
PDF Word ODT
5.0 Stars | 18 Ratings
357 Downloads

Updated February 06, 2023

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. It is required by federal law in all 50 states to be filed for the finalization of the sale and allows the buyer of the vehicle to apply for registration (along with the title, bill of sale, and any other required forms).

Depending on the state, there may be a state-specific odometer disclosure statement provided by the Department of Motor Vehicles (DMV).

Federal law – 49 U.S. Code § 32705 (Disclosure requirements on transfer of motor vehicles)

Odometer Disclosures – By State

State Form
 Alabama Form MVT 5-5
 Alaska Form 839
 Arizona Use Federal Form
 Arkansas Included in the Bill of Sale
 California Form REG 256
 Colorado Use Federal Form
 Connecticut Use Federal Form
 Delaware Use Federal Form
 Florida Form HSMV 82042
 Georgia Form GA-25
 Hawaii Included in the Bill of Sale
 Idaho Use Federal Form
 Illinois Form VSD 333.4
 Indiana Form 43230
 Iowa Form 411077
 Kansas Form TR-59
 Kentucky Form TC 95-5
 Louisiana Form DPSMV 1606
 Maine Form MVT-32
 Maryland Form VR-197
 Massachusetts Use Federal Form
 Michigan BDVR-108
 Minnesota Use Federal Form
 Mississippi Form 78-015
 Missouri Form 1545
 Montana Form MV90-A
 Nebraska DMV Form
 Nevada Use Federal Form
 New Hampshire Form TDMV-12
 New Jersey Form OS/SS UTA
 New Mexico Form MVD–10187
 New York Form MV-103
 North Carolina Form MVR-180
 North Dakota Use Federal Form
 Ohio Form BMV-3724
 Oklahoma Form 729
 Oregon Use Federal Form
 Pennsylvania Use Federal Form
 Rhode Island Use Federal Form
 South Carolina Use Federal Form
 South Dakota Form DMV-611
 Tennessee Form RV-F1317001
 Texas Use Federal Form
 Utah Form TC-891
 Vermont Use Federal Form
 Virginia Form VSA-5
 Washington View Instructions
Washington D.C. Use Federal Form
West Virginia Form DMV-TM-1
 Wisconsin Use Federal Form
 Wyoming Use Federal Form

 

Sample

ODOMETER DISCLOSURE STATEMENT

Federal and State law 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, [SELLER’S NAME], state that the odometer now reads [#] miles (NO TENTHS) 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 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

VEHICLE DETAILS

  • MAKE : [MAKE]
  • BODY STYLE: [BODY STYLE]
  • MODEL: [MODEL]
  • YEAR: [YEAR]
  • VEHICLE IDENTIFICATION NUMBER (VIN): [17 DIGITS]

LAST PLATE STATE: [STATE]

LAST PLATE NUMBER: [PLATE #]

SELLER’S SIGNATURE: ___________________________ DATE: ___________________________

PRINT NAME: ___________________________

SELLER’S ADDRESS: ___________________________________________________

ACKNOWLEDGING MILEAGE READING AS CERTIFIED

BUYER’S SIGNATURE: ___________________________ DATE: ___________________________

PRINT NAME: ___________________________

BUYER’S ADDRESS: ___________________________________________________

DATE OF CERTIFICATION: ___________________________

The provisions of this disclosure statement section shall not apply to the following transfers:

(1) A vehicle having a gross vehicle weight rating of more than 16,000 pounds;

(2) A vehicle that is not self-propelled;

(3) A vehicle that is 10 years old or older; or

(4) A new vehicle prior to its first transfer for purposes other than resale.

(5) A new vehicle sold directly by the manufacturer to any agency of the United States in conformity with contractual specifications.

For the comprehensive document, please download the free form or hit “create document.”