Form 3019 - Odometer Disclosure Statement

1 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.

2 mileage in excess of its mechanical limits mileage reading not actual (WARNING, Odometer DISCREPANCY)SIGNATURE OF PURCHASER(S) SIGNATURE OF SELLER(S)HAND PRINTED NAME(S) BY PURCHASER(S) HAND PRINTED NAME(S) BY SELLER(S)PURCHASER(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. mileage in excess of its mechanical limits mileage reading not actual (WARNING, Odometer DISCREPANCY)SIGNATURE OF PURCHASER(S) SIGNATURE OF SELLER(S)HAND PRINTED NAME(S) BY PURCHASER(S) HAND PRINTED NAME(S) BY SELLER(S)PURCHASER(S) NAME DATE(PRINTED OR TYPED)ADDRESSSELLER(S) (FIRM) NAME DEALER NO.

3 (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. mileage in excess of its mechanical limits mileage reading not actual (WARNING, Odometer DISCREPANCY)SIGNATURE OF PURCHASER(S) SIGNATURE OF SELLER(S)HAND PRINTED NAME(S) BY PURCHASER(S) HAND PRINTED NAME(S) BY SELLER(S)PURCHASER(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.

4 mileage in excess of its mechanical limits mileage reading not actual (WARNING, Odometer DISCREPANCY)SIGNATURE OF PURCHASER(S) SIGNATURE OF SELLER(S)HAND PRINTED NAME(S) BY PURCHASER(S) HAND PRINTED NAME(S) BY SELLER(S)When a certificate of title or a manufacturer s Statement of origin does not meet the federal requirements for a proper Odometer Disclosure , a separate Odometer Disclosure Statement must be issued by the seller and attached to the certificate of ownership at the time of transfer of a motor following vehicles are exempt from the Odometer requirements: 1. Model year 2010 or older and at least ten years of age at the time of ownership transfer; 2. Model year 2011 or newer and at least twenty years of age at the time of ownership transfer; 3. Any motor vehicle having a gross vehicle weight rating of more than 16,000 pounds; and 4.

5 Any new motor vehicle transferred from one franchise dealer to the Missouri title was issued after August 28, 1989, the Odometer Disclosure is required to be completed on the back of the title rather than on a separate Disclosure THE Odometer Disclosure STATEMENT1. All information on the Disclosure Statement can be typed or computer generated except for the printed names and signatures of the purchaser(s) and seller(s).2. One purchaser and one seller must sign the One purchaser and one seller must hand print their The seller must state the exact mileage as listed on the Odometer at the time of transfer, excluding tenths. If there is a discrepancy in the number of miles shown, one of the mileage blocks must be checked: mileage in Excess of Mechanical Limits If the actual mileage of the vehicle is 125,000 but only 25,000 is shown on the Odometer , the seller must insert 25,000 in the Odometer reading area and check the box stating mileage in Excess of Mechanical Limits.

6 mileage Reading Is Not Actual If the true mileage is different from the mileage shown on the Odometer or the true mileage is unknown, the seller must submit a Statement explaining all facts concerning the true mileage versus the mileage shown on the CORRECTIONS ON Odometer Disclosure STATEMENTSIf an error should occur when completing the second, third, or fourth Odometer Disclosure space on the Odometer Disclosure Statement , the seller should:1. Draw a large X in that Disclosure space;2. Make the correct Disclosure in the next Disclosure space;3. Ensure that the purchaser and seller complete and sign a Statement explaining the error and attach it to the Odometer Disclosure : Both documents must accompany the application for the error is made while completing the fourth Disclosure space, a new Odometer Disclosure Statement should be attached to the original Disclosure Statement , accompanied by the Statement explaining the site address: 860-2086 (01-2021)