Odometer/Mileage Disclosure Statement

YearMakePlease complete, sign and submit the form by Fax: 1-877-501-7620 Or mail: chase AutoODOMETER Disclosure Statement (LEASED VEHICLES)Federal law (and State law, if applicable) requires that the lessee disclose the mileage to the lessor in connection with the transfer of ownership. Failure to complete or making a false Statement may result in fines and/or returning or purchasing your leased vehicle, please complete, sign and return Disclosure form below to JPMorgan chase Bank, (print name of person making Disclosure ), state that the odometer now reads(no tenths) further state the following (please place a checkmark next to only one of the following statements):I certify that, to the best of my knowledge, the above-listed odometer reading reflects the ACTUAL MILEAGE of the vehicle described certify that, to the best of my knowledge, the above-listed odometer reading reflects the amount of mileage IN EXCESS OF ITS MECHANICAL certify that the above-listed odometer reading is NOT the actual mileage.

transfer of ownership. Failure to complete or making a false statement may result in fines and/or imprisonment. When returning or purchasing your leased vehicle, please complete, sign and return disclosure form below to JPMorgan Chase Bank, N.A. I (print name of person making disclosure), state that the odometer now reads (no tenths) miles.

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  Testament, Transfer, Disclosures, Disclosure statement, Chase

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