Transcription of Form 3019 - Odometer Disclosure Statement
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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.
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.
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