Form Dmv-611 - South Dakota Uniform Mileage Disclosure Statement

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SD EForm - 2020
V1
SOUTH DAKOTA UNIFORM MILEAGE DISCLOSURE STATEMENT
FEDERAL AND STATE LAW REQUIRES THAT YOU DISCLOSE A VEHICLE’S ACTUAL MILEAGE ON EACH TRANSFER OF OWNERSHIP.
Failure to complete or making a false disclosure may result in fines and/or imprisonment. Complete this disclosure statement if the vehicle
being transferred is less than ten (10) years old and weighs less than 16,000 pounds.
Vehicle: _________________________________________________________________________________________________________________
Year
Make
Serial #
Title #
Odometer Reading is: _____________________
(check one) ___miles ___ kilometers, which is the actual vehicle mileage unless one of the
(No Tenths)
following statements is checked.
Stated Mileage: ____ Exceeds Odometer’s Mechanical Limits OR
____ Is not actual mileage – Warning – Odometer Discrepancy
Disclosure Certification: I, as seller, under penalty of South Dakota law, certify by my signature to the truth and accuracy of the disclosure
statement.
_____________________________________________________________ ________________________________________________________
Typed Name of Seller
Typed Name of Purchaser
_____________________________________________________________ ________________________________________________________
Signature of Seller
Date of Sale
Signature of Purchaser
Date of Sale
______________________________________________________________ _________________________________________________________
Seller’s Address
Purchaser’s Address
______________________________________________________________ __________________________________________________________
City
State
Zip Code
City
State
Zip Code
DMV-611 (7-08)
COPY
WHITE ORIGINAL
-- Submit to DMV attached to title
DISTRIBUTION
YELLOW DUPLICATE
-- Seller’s copy
CLEAR FORM
PRINT FOR MAILING

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