Tdmv 22a - Report Of Sale Or Transfer Of A Non-Titled Motor Vehicle

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N.H. DEPARTMENT OF SAFETY
DIVISION OF MOTOR VEHICLES
BUREAU OF TITLE AND ANTI-THEFT
CONCORD, NH 03305 (603) 227-4150
JOHN J. BARTHELMES
RICHARD C. BAILEY, JR.
COMMISSIONER OF SAFETY
DIRECTOR OF MOTOR VEHICLES
REPORT OF SALE OR TRANSFER OF A NON-TITLED MOTOR VEHICLE
MODEL
MAKE OF
BODY
VEHICLE
YEAR
VEHICLE
TYPE
IDENT. NO.
BUYER’S PRINTED NAME(S):
PRINTED ADDRESS:
ODOMETER DISCLOSURE STATEMENT
I certify that, to the best of my knowledge, this odometer reading is
(NO TENTHS) (check one):
Actual Mileage
I certify that, to the best of my knowledge, this odometer reading “EXCEEDS MECHANICAL LIMITS.”
I certify that, to the best of my knowledge, this odometer reading is “NOT THE ACUTAL MILEAGE.
WARNING ODOMETER DISCREPANCY.”
SELLER’S SIGNATURE:
Date:
PRINTED NAME:
ADDRESS:
“I AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER.”
BUYERS’
PRINTED
SIGNATURE:
DATE:
NAME:
TDMV 22A (Rev.07/14)

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