49 CFR Part 580, Appendix B to Part 580 - Disclosure Form for Title

View PDF at GPO Pt. 580, App. B
Appendix B to Part 580—Disclosure Form for Title
Odometer Disclosure Statement
Federal law (and State law, if applicable) requires that you state the mileage in connection with the transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment.
I state that the odometer now reads ___ (no tenths) miles and to the best of my knowledge that it reflects the actual mileage of the vehicle described herein, 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.
(Transferor's Signature)
(Transferee's Signature)
(Printed name)
(Printed name)
Date of Statement
Transferee's Name
Transferee's Address
(City)(State)(ZIP Code)

Title 49 published on 2015-10-01.

No entries appear in the Federal Register after this date, for 49 CFR Part 580.