ODOMETER DISCLOSURE STATEMENT

KENTUCKY TRANSPORTATION CABINET DIVISION OF MOTOR VEHICLE LICENSING TC 96 5 Rev. 06/2015 Page 1 of 1 ODOMETER DISCLOSURE STATEMENT Instructions: Attach this form to your title and registration application documents and forward to your county clerk. Note: Federal law requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false STATEMENT may result in fines and imprisonment under KY ODOMETER law KRS SECTION 1: VEHICLE INFORMATION YEAR MAKE MODEL VIN BODY TYPE SECTION 2: TRANSFEROR/SELLER INFORMATION & STATEMENT NAME (Please print.) PHONE ( ) ADDRESS I, state that the ODOMETER now reads miles and to the (Transferor/Seller s name) (no tenths) best of my knowledge reflects the actual mileage of the vehicle described above unless one of the following statements is checked. I hereby certify that to the best of my knowledge the ODOMETER reflects mileage in excess of its mechanical limits.

Note: Federal law requires that you state the mileage upon transfer of ownership. Failure to complete or providing a Failure to complete or providing a false statement may result in fines and imprisonment under KY odometer law KRS 190.300.

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  Testament, Disclosures, Mileage, Odometer, Odometer disclosure statement

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