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Form 3019 - Odometer Disclosure Statement

MISSOURI DEPARTMENT OF REVENUEMOTOR VEHICLE BUREAU Odometer DISCLOSURESTATEMENTMO 860-2086 (01-2021)FORM3019(REV. 01-2021)Federal law (and State law, if applicable) requires that you state the mileage upon transfer of ownership. Failing to complete or providing a false Statement may result in fines and/or ON REVERSEYEAR MAKE VEHICLE IDENTIFICATION NUMBERTITLE NUMBER STATE MODEL BODY STYLEIf purchaser/seller is an agent/officer of a firm, record official position after printed name. The purchaser/seller should retain a copy of this Odometer Disclosure Statement . If Warning, Odometer Discrepancy is checked, the seller must attach a Statement explaining all facts regarding the (S) NAME DATE(PRINTED OR TYPED)ADDRESSSELLER(S) (FIRM) NAME DEALER NO.(PRINTED OR TYPED)ADDRESSODOMETER READING(NO TENTHS)I state that the Odometer now reads the aforementioned 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.

ODOMETER DISCLOSURE. STATEMENT. MO 860-2086 (01-2021) FORM. 3019 (REV. 01-2021) Federal law (and State law, if applicable) requires that you state the mileage . upon transfer of ownership. Failing to complete or providing a false statement may result in fines and/or . INSTRUCTIONS ON REVERSE. imprisonment. YEAR MAKE VEHICLE IDENTIFICATION …

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  Testament, Disclosures, Mileage, Odometer, Odometer disclosure statement, Odometer disclosure

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