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 188,100 (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

2010

Make

Toyota

Model

Prius II

Body

Hatchback

VIN

JTDKN3DU5A0100001

Stock #

26-0012

Color

Silver

Transferor (seller)

Demo Auto Sales

1500 W Sample St, Sioux Falls, SD 57106

(555) 555-0142

Dealer license #D-10482

Transferee (buyer)

Kevin O'Neal

1385 Elm St Sioux Falls, SD 57108

Seller signatureDate

Buyer signatureDate

Date of statement: Jan 1, 2026

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