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, _________________________________________ (Name of person making disclosure)
(Print)
hereby state that the odometer 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.