Odometer Disclosure Statement Template
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1ODOMETER DISCLOSURE STATEMENT
FEDERAL LAW (AND STATE LAW, IF APPLICABLE) REQUIRES THAT THE LESSEE
DISCLOSE THE MILEAGE TO THE LESSOR IN CONNECTION WITH THE TRANSFER OF
OWNERSHIP. FAILURE TO COMPLETE OR MAKING A FALSE STATEMENT MAY RESULT IN
FINES AND/OR IMPRISONMENT. COMPLETE THE DISCLOSURE FORM BELOW AND
RETURN TO LESSOR.
I, ______________________________________, STATE THAT THE ODOMETER NOW READS
________________ (NO TENTHS) MILES AND TO THE BEST OF MY KNOWLEDGE THAT IT
REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE DESCRIBED BELOW, UNLESS ONE OF
THE FOLLOWING IS CHECKED.
(1) 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) I HEREBY CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL MILEAGE.
WARNING – ODOMETER DISCREPANCY.
YEAR
MAKE
MODEL
BODY
VEHICLE IDENTIFICATION NO.
LESSEE INFORMATION
Lessee’s Name:
Co-Lessee’s Name:
Address:
City, State ZIP:
Account Number:
Lessee’s Signature:
Date of Statement
LESSOR INFORMATION
Honda Lease Trust or HVT, Inc. or HVT, Inc., as Trustee for Honda Lease Trust
20800 Madrona Avenue
Torrance, CA 90503
Date Form Sent to Lessee
Date Completed Form Received from Lessee
Lessor’s Signature
Honda Lease Trust or HVT, Inc. or HVT, Inc., Trustee for Honda Least Trust
Honda Financial Services is a DBA of American Honda Finance Corporation
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