(Seller/Agent Name)
ODOMETER DISCLOSURE
STATEMENT
VTR-40 (Rev. 11/09)
DHT # 142235
Federal and State Law require that you state the mileage in connection with the transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment. This form may not be used in conjunction with title transfer documents, which comply with federal and state odometer disclosure requirements such as Texas Certificate of Titles issued on or after April 29, 1990.
VEHICLE DESCRIPTION
Vehicle Identification Number
I, ______________________________________________, certify to the best of my knowledge that the odometer reading is
the actual mileage of the vehicle described above unless one of the following statements is checked:
1.The mileage stated is in excess of its mechanical limits.
2.The odometer reading is not the actual mileage.
WARNING – ODOMETER DISCREPANCY.
Date ofSignature of Seller/AgentPrinted Name (Same as Signature) Statement
If titled in a firm’s name, print the firm’s name on the line above.
Street Address |
City |
State |
Zip Code |
ACKNOWLEDGMENT OF ODOMETER DISCLOSURE BY BUYER/AGENT
I am aware of the above odometer certification made by the seller/agent.
Date of |
Signature of Buyer/Agent |
Printed Name (Same as Signature) |
Statement |
|
|
If purchased by a firm, print the firm’s name on the line above.
Street Address |
City |
State |
Zip Code |
WARNING: TRANSPORTATION CODE, §501.155, PROVIDES THAT FALSIFYING INFORMATION ON ANY REQUIRED STATEMENT OR APPLICATION IS A THIRD-DEGREE FELONY.