Odometer Disclosure Statement
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1Motor Vehicle Administration
VR-197 (01-13)
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
Odometer Disclosure Statement
Federal and State law requires that you state the mileage in connection with the transfer
of ownership. Failure to complete or providing a false statement may result in fines and/or
imprisonment.
I, (print seller’s name)
certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle
unless one of the following statements is checked:
miles (no tenths)
The mileage stated is in excess of its mechanical limits
K
The odometer reading is not the actual mileage. Warning - odometer discrepancy
K
Make:
Model:
Year:
Body Type:
Vehicle Identification No.:
Seller’s Signature:
Seller’s Printed Name:
Seller’s Street Address:
City:
State:
Zip Code:
Date of Statement:
Buyer’s Signature:
Buyer’s Printed Name:
Buyer’s Street Address:
City:
State:
Zip Code:
White Copy - MVA
Canary Copy - Seller
Pink Copy - Buyer
For more information, please call: 410-768-7000 (to speak with a customer service representative).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at:
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