This document is an odometer disclosure waiver form from the Utah State Tax Commission. It allows a new vehicle owner to obtain a title if the previous owner did not provide an odometer disclosure statement. The new owner must print their name, the vehicle's odometer reading, and certify the accuracy of the reading. They also release the state of Utah from any liability regarding the issuance of the title with the provided odometer information.

1. Clear form
Utah State Tax Commission
Get forms online - tax.utah.gov
TC-893
Rev. 7/03
Odometer Disclosure Waiver
Division of Motor Vehicles · 210 North 1950 West · Salt Lake City, Utah 84134 · (801) 297-7780. If you need an accommodation under the
American with Disabilities Act, contact the Tax Commission at (801) 297-3811 (TDD (801) 297-2020). Please allow three working days
for a response.
DO NOT USE THIS FORM IF THE VEHICLE WAS PURCHASED FROM A LICENSED DEALER
Vehicle Identification Number:
Vehicle Year: Make: Model:
Federal Public Law 49, Part 580 and Utah Code Title 41 require the seller of a motor vehicle to inform the buyer of
that vehicle about the vehicle's mileage, and to provide written disclosure of that mileage on the title or other
authorized transfer document for that vehicle.
I recently acquired and am now the legal owner of the vehicle described above; but the previous owner from whom I
acquired this vehicle did not provide me with the written odometer disclosure statement required by these laws and I
have not been able to contact him to obtain this statement.
I request that a Utah title be issued to me, and I submit application to the Motor Vehicle Division herewith for both title
and registration for this vehicle. Instead of the odometer disclosure from the seller, I offer the following statement:
I,
(PRINT New Owner's Name)
Odometer reading
(no tenths)
Check only one box
I certify that to the best of my knowledge the odometer reading reflects the actual mileage.
I certify that to the best of my knowledge the odometer reading reflects the amount of mileage in excess of
its mechanical limits.
I certify that the odometer reading is not the actual mileage. Warning-odometer discrepancy
I understand that the mileage I have shown will be printed on the title you issue. I hereby release the State of Utah,
the Utah State Tax Commission, the Motor Vehicle Division, and all persons acting under its direction, from any and
all liability arising out of the issuance of this title, and I shall defend at (my/our) expense any claim or litigation which
may result.
New Owner(s) Signature
X
Address City State Zip
WARNING
MAKING FALSE STATEMENT OR MAKING FRAUDULENT APPLICATIONS IS A CRIME
[Utah Code Title 41]