Odometer Disclosure Statement
Information
1. FEDERAL LAW requires that you state the mileage upon transfer of ownership. Failure to complete this disclosure statement or
providing false information may result in fines and/or imprisonment.
2. Any person who knowingly or willfully misrepresents the description of a vehicle or makes a false statement in any title papers, forges,
changes or counterfeits a part of title papers, or uses title papers on or for the wrong motor vehicle is subject to civil, criminal and
administrative penalties.
3. This odometer statement may be signed digitally but must be accompanied by a Certificate of Completion for each digital signature. If
signed with a wet signature, this odometer statement will be accepted as is.
4. This odometer disclosure statement is only a supplement to a fully assigned Certificate of Title or Manufacturer Certificate of Origin
(MCO). This form must accompany an original title or MCO document when submitted to MVC.
5. This odometer statement must be notarized for Mileage Corrections when using a wet signature.
Step 1 – Vehicle Information
Vehicle Identification Number Body Type
Year Make Model
Step 2 – Buyer Information
Buyer/MVC Entity Name Owner Driver License Number/MVC Business Entity Identification Number
Buyer Address City/Town State Zip Code
Step 3 – Seller Information
Seller Name Date of Sale
Seller Address City/Town State Zip Code
Date of Odometer Statement
Step 4 – Odometer Information
I certify that the odometer reading on the vehicle described above is _________________________ (don’t show
tenths) and to the best of my/our knowledge this number reflects the actual mileage of the vehicle unless one of
the following statements is checked:
I hereby certify that to the best of my/our knowledge the odometer has exceeded its mechanical limit and
the reading started again at 0.
WARNING – ODOMETER DISCREPANCY – I hereby certify that the odometer reading is NOT the
actual mileage and should not be relied upon for accuracy.
Step 5 – Statement of Buyer
I the undersigned, hereby certify that the motor vehicle described above and on the attached certificate
of ownership, or MCO, was purchased by me/us and I have compared the vehicle identification number
shown on this certificate with that of the motor vehicle purchased and found that they agree in every particular.
Note: N.J.S.A. 39:10-11 requires that the attached certificate, after assignment, be presented to the Motor
Vehicle Commission within 10 days. Failure to do so will result in a penalty of $25, which will be an addition to
the filing fee for a new certificate of ownership.
Step 6 – Signature
__________________________________________________ ______________________________
Seller’s Signature Date
__________________________________________________ ______________________________
Buyer’s Signature Date
Motor Vehicle Commission Use Only
Clerk Initials:
Transaction Number:
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