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 104,600 (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

2017

Make

Ford

Model

Fusion SE

Body

Sedan

VIN

3FA6P0H73HR100001

Stock #

26-0009

Color

Gray

Transferor (seller)

Demo Auto Sales

1500 W Sample St, Sioux Falls, SD 57106

(555) 555-0142

Dealer license #D-10482

Transferee (buyer)

Ashley Nguyen

1274 Cedar St Sioux Falls, SD 57105

Seller signatureDate

Buyer signatureDate

Date of statement: May 11, 2026

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