New Jersey
Motor Vehicle Commission
P.O. Box 017
Trenton, NJ 08666-0017
STATE OF NEW JERSEY
1-888-486-3339 (in state)
1-609-292-6500 (out of state)
Odometer Disclosure Statement
I/We hereby assign and warrant Certificate of Ownership of the vehicle described on the attached Certificate of Ownership.
I/We further certify the accuracy of the mileage as specified below.
VEHICLE DESCRIPTION
Year: _________ Make: _________________Model:_______________Body Type________
VIN: ______________________________ Dr. License: ______________________________
(Print) _________________________________ Corpcode # ________________________________
BUYER NAME
Buyers Address: _____________________________________________________________________________________
SELLER NAME
(Print) _________________________________________________________________________
Seller Address ______________________________________________________________________________________
Date of sale _________________________
NOTE FEDERAL LAW requires that you state the mileage upon transfer of ownership. Failure to complete this disclosure
statement or providing false information may result in fines and/or imprisonment.
I/We state that the odometer now reads______________________ (do not show tenths) and to the best of my/our knowledge
that reflect the actual mileage of the vehicle described on the attached certificate of ownership, unless one of the following
statements is checked.
_____ (1) I/We hereby certify that to the best of my/our knowledge the odometer has exceeded its mechanical limit and the
reading started again at zero.
_____ (2) WARNING-ODOMETER DISCREPANCY- I/We hereby certify that the odometer reading is NOT the actual
mileage, and should not be relied upon for accuracy.
NOTE: New Jersey statute provides that anyone who knowingly or willfully misrepresents the description of a vehicle or makes a false
statement in any title papers, forges, changes or counterfeits a part of title papers, or uses title papers on or for the wrong motor vehicle is
guilty of a misdemeanor.
Seller’s Signature X______________________________________________________________________
SELLERS SIGN
HERE
Seller’s Name (Hand Print) _______________________________________________________________
Seller’s Signature X ____________________________________________________________________
Seller’s Name (Hand Print) _________________________________________________________________
Date of Odometer Statement _______________________________________________________________
STATEMENT OF BUYER
I/We the undersigned, hereby certify that the motor vehicle described on the attached certificate of ownership was purchased by
me/us and I/we have compared the vehicle identification number shown on this certificate with that of the motor vehicle
purchased and found that they agree in every particular.
NOTE: N.J.S.A. 39:10-11 requires that the attached certificate after assignment be presented to the Motor Vehicle Commission within 10 days. Failure to do so
will result in a penalty of $25 which will be in addition to the filing fee for a new certificate of ownership.
Buyer’s Signature X __________________________________________________________________
BUYERS SIGN HERE
Buyer’s Name (Hand Print) ____________________________________________________________
Buyer’s Signature X __________________________________________________________________
Buyer’s Name (Hand Print) ____________________________________________________________
NOTE: THIS ODOMETER DISCOLOSURE STATEMENT IS ONLY A
SUPPLEMENT TO A FULLY ASSIGNED CERTIFICATE OF TITLE.
OS/SS-2 (R5/10)