Odometer Disclosure Statement

Federal law (and state law, if applicable) requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment.

I, Demo Auto Sales, state that the odometer now reads 141,200 (no tenths) miles and to the best of my knowledge that it reflects the actual mileage of the vehicle described below, unless one of the following statements is checked.

I hereby certify that to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits.

I hereby certify that the odometer reading is NOT the actual mileage. WARNING: ODOMETER DISCREPANCY.

Year

2015

Make

Jeep

Model

Grand Cherokee Laredo

Body

SUV

VIN

1C4RJFAG0FC600001

Stock #

26-0008

Color

White

Transferor (seller)

Demo Auto Sales

1500 W Sample St, Sioux Falls, SD 57106

(555) 555-0142

Dealer license #D-10482

Transferee (buyer)

James Carter

1237 Oak St Sioux Falls, SD 57104

Seller signatureDate

Buyer signatureDate

Date of statement: Jun 10, 2026

Federal odometer law: 49 U.S.C. 32705 and 49 CFR Part 580. Some states require their own form or electronic title disclosure.