82042
82042
82042
Vehicle Identification Number Year Make Color Body Previous State Vehicle Titled In
ODOMETER DECLARATION
WARNING: Federal and State law require that you state the mileage in connection with an application for a
Certificate of Title. Failure to complete or providing a false statement may result in fines and/or imprisonment.
I /WE STATE THAT THIS 5 OR 6 DIGIT ODOMETER NOW READS , .XX (NO TENTHS) MILES,
DATE READ _______/_______/_______ AND I/WE HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE
ODOMETER READING:
1. reflects ACTUAL MILEAGE. 2. is IN EXCESS OF ITS MECHANICAL LIMITS. 3. is NOT THE ACTUAL MILEAGE.
_________________________________________________ ______________________________________________
(Owner’s Signature) (Owner’s Printed Name)
Date: