STATE OF ARKANSAS VEHICLE BILL OF SALE/ODOMETER DISCLOSURE STATEMENT
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Section 1 - Vehicle Identification Number (VIN)
If buyer is a company rather than individuals, go directly to Section 3 - Company Name.
Section 2 - Buyer Information
First Name
Middle Initial
Last Name
Address
City, State, Zip
Check this box if there are multiple owners
Section 3 - Company Information
Company Name
Company Address
City, State, Zip
Section 4 - Dealer/Seller Name and Address
Dealer/Seller Name
Address
City, State, Zip
Section 5 - Purchase Date
Section 6 - Description of Vehicle Purchased and Vehicle Trade-In
Vehicle Purchased
Year
Primary Color
Secondary Color (If applicable)
Make
Model
Vehicle Trade-In
Make
Model
Year
Vehicle Identification Number of Trade-In
Section 7 - Odometer Disclosure
I,
(sellers printed name) hereby state that the Odometer now reads
(no tenths) miles, and the best of my knowledge that it reflects the actual miles, UNLESS one
of the items below is checked:
1. EXCEEDS MECHANICAL LIMITS - I hereby certify that to the best of my knowledge the odometer reading
reflects the amount of mileage in excess of its mechanical limits.
2. WARNING - ODOMETER DISCREPANCY -I hereby certify that the odometer reading is not the actual mileage.
Section 8 - Sales Price Information - Signatures
Printed Name of Seller
Full Sales Price of Vehicle
Signature of Seller
Less Trade-In
Printed Name of Buyer
Net Taxable Income
Signature of Buyer
SECTION 9 - WARNING
WARNING: It is a FELONY for any taxpayer to willfully attempt to evade or defeat the payment of any tax, penalty, or interest due under state
law; OR for any person to willfully assist a taxpayer in evading or defeating the payment of any tax, penalty, or interest due under state law.
This form may be reproduced so long as the format and language are not changed from the original.
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