Form Tr-59 - Odometer Disclosure Statement
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1KANSAS
Department of Revenue
Division of Vehicles
Topeka, Kansas 66626-0001
ODOMETER DISCLOSURE STATEMENT
Title Number
Title issued by state of
Original odometer disclosure statement for vehicle on title listed above.
Correction to odometer disclosure statement for vehicle listed below.
Odometer statement for transfer of vehicle without title (legal affidavit/court document).
Federal/State Law requires that you state the mileage upon transfer of ownership. Failure to
complete or providing a false statement may result in fines and/or imprisonment.
I,
(transferor’s name – please print)
certify that the odometer now reads
(no tenths) miles.
To the best of my knowledge, the mileage is:
ONE
ONLY
BOX MUST BE CHECKED
(1) Actual mileage
(2) In excess of its mechanical limits
(3) NOT the actual
WARNING . . . ODOMETER DISCREPANCY
*** Transferor – Seller; Transferee – Buyer ***
Year
Make
Model
Body Style
Vehicle Identification Number
Date of Statement
Transferor’s Signature (seller)
Transferor’s Name (Hand Printed)
Street
City
State
Zip Code
Transferee’s Signature (buyer)
Transferee’s Name (Hand Printed)
Street Address
City
State
Zip Code
Original-Attach to Title
Copy- Seller’s Copy
Copy- Buyer’s Copy
TR-59 www(603)
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Parent category: Financial