Use this to disclose the miles, date, and parties invloved in a vehicle sale or transfer transaction. this is extremely valuable if the vehicle is stolen, damaged, ticketed or used for an illegal purpose after the transfer is made. Brought to you by McGrath Honda of St Charles.

1. Print Reset
Secretary of State This space for use by Secretary of State This space for use by
Secretary of State Secretary of State
Odometer Disclosure Statement for Title Transfers Odometer Disclosure Statement for Title Transfers
Secretary of State Secretary of State
Vehicle Services Department Federal and state laws require that you state the mileage Vehicle Services Department Federal and state laws require that you state the mileage
501 S. Second St., Rm. 424 in a transfer of ownership. Failure to complete or 501 S. Second St., Rm. 424 in a transfer of ownership. Failure to complete or
Springfield, IL 62756 providing a false statement may result in fines and/or Springfield, IL 62756 providing a false statement may result in fines and/or
imprisonment. imprisonment.
www.cyberdriveillinois.com www.cyberdriveillinois.com
I, , certify to the best of my knowledge that the odometer I, , certify to the best of my knowledge that the odometer
Seller’s name (type or print) Seller’s name (type or print)
reading now reads (no tenths) miles and reflects the actual mileage of the vehicle described reading now reads (no tenths) miles and reflects the actual mileage of the vehicle described
below, unless one of the following statements is checked: below, unless one of the following statements is checked:
❏ The mileage stated is in excess of its mechanical limits. ❏ The mileage stated is in excess of its mechanical limits.
❏ The odometer reading is not the actual mileage. Warning odometer discrepancy. ❏ The odometer reading is not the actual mileage. Warning odometer discrepancy.
Year Make Body Type Model Year Make Body Type Model
Vehicle Identification Number Vehicle Identification Number
Seller’s Signature Seller’s Signature
Seller’s Printed Name Seller’s Printed Name
Seller’s Address Seller’s Address
Street Street
City, State, ZIP City, State, ZIP
Seller’s Certification Date Seller’s Certification Date
To be completed by the buyer To be completed by the buyer
Buyer’s Signature Buyer’s Signature
Buyer’s Printed Name Buyer’s Printed Name
Buyer’s Address Buyer’s Address
Street Street
City, State, ZIP City, State, ZIP
Buyer’s Acknowledgement Date Buyer’s Acknowledgement Date
Printed by authority of the State of Illinois - August 2005 - 45M - VSD 333.2 Printed by authority of the State of Illinois - August 2005 - 45M - VSD 333.2