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SEPARATE ODOMETER DISCLOSURE STATEMENT AND …

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTORIST SERVICES SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE SEPARATE ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT VEHICLE DESCRIPTIONV ehicle Identification Number Year Make color Body Title Number ODOMETER DISCLOSURE STATEMENT WARNING: Federal and State law requires that you state the mileage in connection with an application for a Certificate of Title. Failure to complete or providing a false STATEMENT may result in fines and/or imprisonment. WE STATE THAT THIS 5 or 6 DIGIT ODOMETER NOW READS , .XX (NO TENTHS) MILES, DATE READ _____/_____/_____, AND WE HEREBY CERTIFY THAT TO THE BEST OF OUR KNOWLEDGE THE ODOMETER READING: 1. REFLECTS ACTUAL MILEAGE.

Year Make Color Body Title Number ODOMETER DISCLOSURE STATEMENT WARNING: Federal and State law requires that you state the mileage in connection with an application for a Certificate of Title. Failure to complete or providing a false …

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