by Gauk
Wed, Jul 13, 2016 11:40 PM

ODOMETER (MILEAGE) STATEMENT

(Use this free template when buying a used car to declare that the odometer reading is correct)

I, the seller……………………………………………………………. state that the odometer mileage on the vehicle described below now reads……………………….miles/kilometers(delete as reqiured).

Seller address:

 

 

Circle ONE only:

(1) I hereby certify that to the best of my knowledge the odometer reading as stated above reflects the actual mileage of the vehicle described below.

(2) I hereby certify that to the best of my knowledge the odometer reading as stated above reflects the amount of mileage in excess of designed mechanical odometer limit of 99,999 miles/kilometers of the vehicle described below.

(3) I hereby certify that to the best of my knowledge the odometer reading as stated above is NOT the actual mileage of vehicle described below and should not be relied upon.

Make:
Model:
Body Type:
Vehicle Identification No:
Year:
Dealer Stock No:

Circle ONE only:

(1) I hereby certify that the odometer of said vehicle was not altered, set back, or disconnected while in my possession, and I have no knowledge of anyone doing so.

(2) I hereby certify that the odometer was altered for repair or replacement purposes while in my possession, and that the mileage registered on the repaired or replacement odometer was identical to that before such service.

(3) I hereby certify that the repaired or replacement odometer was incapable of registering the same mileage, that it was reset to zero, and that the mileage on the original odometer or the odometer before repair was………………………………….miles/kilometers.

 

Seller’s signature……………………………………………………………Date…………………………

 

Buyer’s name………………………………………………………………….

 

Buyer’s signature…………………………………………………………….Date…………………………

Buyer’s address:

published by Gauk