Seller’s Affidavit – Odometer Reading Disclosure Statement (Fillable)

CHECK ONE OF THE FOLLOWING STATEMENTS. I (WE) CERTIFY THAT: To the best of my (our) knowledge, the Odometer reading reflects the actual mileage; The odometer reading reflects mileage in excess of the designed mechanical limit of 99,999 miles; To the best of my (our) knowledge, the Odometer reading is not the actual mileage and should not be relied upon. CHECK ONE OF THE FOLLOWING. I (WE) CERTIFY THAT WHILE IN MY (OUR) POSSESSION: The Odometer of this vehicle was not altered, set back, or disconnected; The Odometer of this vehicle was repaired or replaced. DO NOT DETACH FROM TITLE ERASURES & ALTERATIONS VOID THIS STATEMENT, STATE OF OHIO, SELLER’S AFFIDAVIT ODOMETER READING DISCLOSURE STATEMENT (TYPE OR PRINT IN INK) NOTICE TO TRANSFEROR: YOU ARE REQUIRED BY LAW TO ENTER ALL INFORMATION REQUIRED HEREIN, INCLUDING THE ODOMETER READING OF THE MOTOR VEHICLE IN THE AFFIDAVIT IMMEDIATELY FOLLOWING. THE MAKING OF A FALSE STATEMENT UNDER OATH OR AFFIRMATION IS IN VIOLATION OF SECTION 2921.13 OF THE REVISED CODE AND IS PUNISHABLE BY SIX MONTHS IMPRISONMENT AND A FINE OF UP TO ONE THOUSAND DOLLARS, OR BOTH. Enter County Date Year MFR’s serial number Make Model Body type Purchaser’s name I (we) certify that the mileage registered on this vehicle at the time of assignment is, enter Mileage (miles) To the best of my (our) knowledge, the Odometer reading reflects the actual mileage (check box) The odometer reading reflects mileage in excess of the designed mechanical limit of 99,999 miles (check box) To the best of my (our) knowledge, the Odometer reading is not the actual mileage and should not be relied upon (check box) The Odometer of this vehicle was not altered, set back, or disconnected (check box) The Odometer of this vehicle was repaired or replaced (check box)