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Preview - Texas Odometer Statement Form
(Seller/Agent Name)
ODOMETER DISCLOSURE
STATEMENT
DHT # 142235
Federal and State Law require 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. This form may not be used in conjunction with title transfer documents, which comply with federal and state odometer disclosure requirements such as Texas Certificate of Titles issued on or after April 29, 1990.
VEHICLE DESCRIPTION
Year
Make
Body Style
Model
Vehicle Identification Number
I, ______________________________________________, certify to the best of my knowledge that the odometer reading is
the actual mileage of the vehicle described above unless one of the following statements is checked:
Odometer
Reading |
(No Tenths) |
1.The mileage stated is in excess of its mechanical limits.
2.The odometer reading is not the actual mileage.
WARNING – ODOMETER DISCREPANCY.
Date ofSignature of Seller/AgentPrinted Name (Same as Signature) Statement
If titled in a firm’s name, print the firm’s name on the line above.
Street Address |
City |
State |
Zip Code |
ACKNOWLEDGMENT OF ODOMETER DISCLOSURE BY BUYER/AGENT
I am aware of the above odometer certification made by the seller/agent.
Date of |
Signature of Buyer/Agent |
Printed Name (Same as Signature) |
Statement |
|
|
If purchased by a firm, print the firm’s name on the line above.
Street Address |
City |
State |
Zip Code |
WARNING: TRANSPORTATION CODE, §501.155, PROVIDES THAT FALSIFYING INFORMATION ON ANY REQUIRED STATEMENT OR APPLICATION IS A
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Similar forms
- Vehicle Title Application: Similar to the Texas Odometer Statement, a Vehicle Title Application requires accurate information about the vehicle’s ownership and mileage. It serves as an official request to transfer ownership and includes necessary details such as the Vehicle Identification Number (VIN).
- Bill of Sale: A Bill of Sale documents the transaction between the buyer and seller. It includes the vehicle’s details, including the odometer reading at the time of sale. This document provides proof of ownership transfer and protects both parties in the transaction.
- Trailer Bill of Sale: The Trailer Bill of Sale is essential for documenting the sale of a trailer and should be completed to ensure proper ownership transfer. This form is particularly important in Washington, and you can learn more about it through the Motor Vehicle Bill of Sale.
- Transfer of Title Form: This form is used to officially transfer a vehicle’s title from one owner to another. It requires the seller to disclose the odometer reading, ensuring that the new owner is aware of the vehicle's mileage at the time of transfer.
- Odometer Disclosure Statement (Federal Form): This federally mandated form is similar to the Texas Odometer Statement. It requires sellers to disclose the odometer reading when transferring ownership of a vehicle, ensuring compliance with federal regulations regarding odometer fraud.
- State-Specific Odometer Disclosure Forms: Many states have their own versions of odometer disclosure forms. Like the Texas Odometer Statement, these forms require the seller to certify the accuracy of the odometer reading, helping to prevent fraud during vehicle sales.