The Mississippi DOR Odometer Disclosure Statement, Form 78-015 (Rev. 09/17), is the document that records a vehicle’s true mileage at the moment ownership changes hands, and both the seller and buyer must complete and sign it during a Mississippi title transfer. The form is issued by the Mississippi Department of Revenue Motor Vehicle Services bureau, and it backs up the odometer line printed on the back of the title. When the title has no usable odometer block, or when you want a clean record of the sale, Form 78-015 fills the gap.
This one page carries real weight. Federal odometer fraud cases can bring fines of up to $10,000 per violation plus possible prison time under federal law, and a single bad entry can get your whole title application kicked back by the county tax collector. Get it right the first time and the transfer moves fast.
Here is what you will learn in this guide:
- 📋 What Form 78-015 is, who must file it, and which vehicles are exempt
- 🖊️ A line-by-line walkthrough of every box, with sample entries you can copy
- 👥 Three real-world filled-out scenarios from start to finish
- 🚫 The top mistakes that get titles rejected and how to dodge them
- ❓ Twelve plain-answer FAQs covering the questions filers ask most
What the Form Is and Who Must File It
The Mississippi Odometer Disclosure Statement is a sworn mileage record tied to the transfer of a motor vehicle. The seller, called the transferor, certifies the odometer reading. The buyer, called the transferee, acknowledges that reading by signing. The form exists because mileage drives a car’s value, and a rolled-back odometer cheats the buyer out of money and safety. Mississippi’s Department of Revenue handles all titling and registration in the state, so this form flows through that agency.
Two layers of law require it. The federal Truth in Mileage Act, found at 49 U.S.C. § 32705, makes mileage disclosure mandatory at the point of sale across all states. Mississippi state law mirrors this rule and ties it to the title transfer process. Because both layers apply, a filer cannot skip the form by pointing to one law alone.
Not every vehicle needs the form. Under the federal rule updated in 2021, disclosure is required for vehicles up to 20 model years old. So in 2026, vehicles from model year 2006 and newer generally need disclosure, while a 2005 or older vehicle falls outside the rolling window. Mississippi has historically also exempted vehicles over 16,000 pounds registered weight, non-motorized trailers, low-speed vehicles, mopeds, and scooters. When in doubt, complete the form anyway, since an extra disclosure never hurts but a missing one can stall your title.
Who actually fills it out? The seller completes the mileage and certification, then both parties sign. A dealer selling to a customer, a private owner selling to a neighbor, and a family member transferring a car as a gift all use this same form. If a power of attorney is involved, special rules apply, and a separate corrected-title affidavit may be needed instead.
Before You Start: Documents and Information You Need
Gather everything before you pick up a pen. Stopping in the middle to hunt for the VIN or a ZIP code leads to messy cross-outs, and cross-outs on a mileage document raise red flags with the county tax collector. A clean, complete form moves through processing without a second look.
Here is your pre-filing checklist:
- The vehicle’s Certificate of Title. You need the exact spelling of names and the VIN that appears on it; a mismatch between the title and this form triggers a hold.
- The current odometer reading. Walk to the car and read it yourself in whole miles; guessing or copying an old number can create a false statement.
- The Vehicle Identification Number (VIN). This 17-character code ties the form to one specific car; a wrong VIN voids the link between the form and the title.
- The make, model, body type, and year. These confirm the vehicle’s identity; leaving them blank gives the clerk no way to match the form to the title.
- The seller’s full legal name and address. It must match the title exactly; a nickname or maiden name can stop the transfer.
- The buyer’s full legal name and address. Enter it as it will appear on the new title; an error here carries onto the buyer’s registration.
- A blue or black ink pen. Pencil and erasable ink are not accepted; a pencil entry can be treated as tampering.
- The date of sale or transfer. This anchors when ownership changed; a missing date can make the disclosure invalid.
If any item is missing, pause and find it before you write. A form built on a guess is worse than no form at all, because a false statement carries legal penalties that a blank line does not.
Where to Get the Form and How to Access It
The official Form 78-015 lives on the Mississippi Department of Revenue website. You can download the official Odometer Disclosure Statement as a fillable PDF, which is the safest source because it is always the current revision. The form’s revision code is 78-015-17-8-1-000 Rev (09/17), printed in small text on the page, so check that you have this version before you write.
You have three easy ways to get the form. First, download it from the DOR form search page and either type into the PDF on your computer or print it and write by hand. Second, visit your local County Tax Collector’s office, where paper copies are usually on hand. Third, many vehicles never need a separate form at all, because the odometer block printed on the back of the Mississippi title does the same job.
To fill it on screen, open the PDF in Adobe Acrobat Reader rather than a web browser preview, which often fails to save your entries. If you print and write by hand, use only blue or black ink. Keep a copy for your own records even after you hand the original to the buyer or the county, since the document protects you if a mileage dispute comes up later.
A quick word on the title’s built-in block. When the title has a clean Assignment of Title by Registered Owner section with an odometer area, you may complete that instead of a separate form. Read every instruction on the title first, because any stray mark or alteration there can void the whole certificate.
Step-by-Step: How to Fill Out Form 78-015 Line by Line
The form is one page broken into a top certification line, a vehicle block, the transferor (seller) block, and the transferee (buyer) block. Fill it in the order the fields appear. Below, each field gets its own walkthrough with a sample entry you can model.
Field 1: “I, ______” (Transferor’s Name on the Certification Line)
This opening line asks the seller to name themselves as the person making the sworn mileage statement. You write your full legal name on the blank, exactly as it appears on the vehicle’s title. For example, James Robert Calhoun writes his name in full rather than “Jim Calhoun.” Use the same name format you will use later in the signature block so the two match.
A common edge case is a co-owned vehicle. If two names appear on the title joined by “and,” both owners may need to sign, so enter the name of the owner who is signing first and confirm whether the second owner must sign too. A frequent mistake here is using a nickname, which can make the clerk question whether the signer is the true owner, and that doubt can stall the title. Many filers wrongly believe this line is just a formality; in truth it is the legal heart of the document, because everything below it is sworn under your named oath.
Field 2: “The Odometer Now Reads ______ (No Tenths)”
This field asks for the exact number of miles showing on the dashboard right now. You write only whole miles and drop any tenths, so a reading of 87,432.6 becomes 87432. Do not add commas inside the boxes if the form uses digit boxes, and never round up or down beyond simply dropping the tenths. Read the odometer in person rather than trusting memory.
For example, Maria Delgado reads 54,219.8 on her dashboard and writes 54219 on the form. The edge case most people hit is a digital odometer that shows a fraction or a trip meter; always record the main lifetime mileage, not the trip counter. The most damaging mistake on this field is including the tenths, because a number like 54219.8 can be read as a different value and may force a corrected affidavit. A common misconception is that “close enough” mileage is fine; it is not, since this is a sworn figure and even an honest guess that proves wrong can look like fraud.
Field 3: The Two Odometer Discrepancy Check Boxes
Right below the reading sit two boxes that you check only if the plain mileage statement is not true. Box (1) reads that the mileage is in excess of the odometer’s mechanical limits, meaning the odometer rolled past its maximum and started over. Box (2) reads that the odometer reading is not the actual mileage, which carries the bold WARNING – ODOMETER DISCREPANCY label. Leave both boxes blank when the reading is honest and accurate.
For example, Earl Watkins sells a 1998 truck whose five-digit odometer reads 12,000 but has actually traveled 112,000 miles, so he checks Box (1) and writes 12000. By contrast, Dana Pruitt knows her odometer broke and was replaced, so she checks Box (2). The biggest mistake here is checking neither box when a discrepancy truly exists, which is itself a false statement and can void the sale. A widespread misconception is that checking a box hurts the sale; in fact, honest disclosure protects you, while hiding a known problem is the act that brings fines and possible prison time.
Field 4: Make
This box asks for the manufacturer of the vehicle. You write the brand exactly as listed on the title, such as FORD, TOYOTA, or CHEVROLET. Use the same spelling and capitalization style the title uses so the records line up. Keep it to the make only, not the model.
For example, James Calhoun writes FORD for his F-150. The edge case to watch is older or rebadged vehicles whose marketing name differs from the legal make; always copy what the title shows. A common mistake is mixing make and model, like writing F-150 in the make box, which confuses the vehicle’s identity record. Some filers think the make is optional because the VIN already identifies the car; the clerk still cross-checks every field, and a blank make can slow the match.
Field 5: Model
The model box names the specific product line of the vehicle. You enter it as it appears on the title, such as F-150, Camry, or Silverado 1500. Include the trim or series number only if the title shows it. Keep the entry short and exact.
For example, Maria Delgado writes CAMRY for her sedan. An edge case appears with vehicles sold under several trim names; default to the model line printed on the title rather than the dealer’s marketing badge. The common mistake is guessing a model from memory and entering the wrong year’s version, which creates a mismatch with the VIN decode. Many people assume model and body type are the same field; they are not, and each box must be filled on its own.
Field 6: Body Type
This field asks what kind of vehicle body the car has, such as 4-DOOR SEDAN, PICKUP, SUV, or COUPE. You write the body style the title lists, since Mississippi titles use set abbreviations. Match the title’s wording rather than inventing your own term. This helps the state classify the vehicle correctly.
For example, Earl Watkins writes PICKUP for his truck. The edge case is a vehicle that has been modified, like a van converted to a camper; still use the body type on the title, not the current use. A frequent mistake is leaving this blank because it feels minor, which can leave the form looking incomplete to the clerk. Some filers believe body type only matters for insurance; in fact the DOR uses it to confirm the form describes the same vehicle as the title.
Field 7: Vehicle Identification Number (VIN)
The VIN box is the single most important identity field on the form. You copy all 17 characters of the VIN exactly as they appear on the title, taking care with look-alike characters. Note that real VINs never contain the letters I, O, or Q, so any character that looks like one is actually the number 1 or 0. Write slowly and double-check every character.
For example, James Calhoun copies 1FTEW1EP5JKD12345 straight from his title. The classic edge case is a faded or hard-to-read title; if you cannot read a character, verify it against the VIN plate on the dashboard or door jamb. The worst mistake on this field is a single transposed character, because the VIN ties the form to the title, and one wrong digit can void that link and force a redo. A common misconception is that a partial VIN is acceptable; the full 17-character VIN is required, and anything shorter will be rejected.
Field 8: Year
This box asks for the vehicle’s model year, not the year you bought it. You enter the four-digit year shown on the title, such as 2018. The model year often differs from the calendar year of purchase, so always trust the title. Write all four digits.
For example, Dana Pruitt writes 2015 for her car. The edge case is a vehicle built late in a calendar year as the next year’s model; the title’s stated year always controls. A common mistake is entering the purchase year instead of the model year, which throws off the 20-year disclosure window calculation. Some filers think the year is obvious and skip it; a blank year box can stall the match against the title.
Field 9: Transferor’s Signature
This is where the seller signs to swear that everything above is true. You sign in your normal handwritten signature using blue or black ink, never typed and never in pencil. Sign only after you have checked the mileage and every other field, because your signature makes the whole page a sworn statement. Do not sign a blank or partly filled form.
For example, James Calhoun signs his name in cursive after confirming the mileage reads 87432. The edge case is a co-owned title that requires two signatures; if the title lists owners joined by “and,” both must sign. The gravest mistake is signing before the form is complete, since you become legally responsible for any wrong entry added later. Many people think a printed name counts as a signature; it does not, and an unsigned certification is not valid.
Field 10: Transferor’s Printed Name
Below or beside the signature, you print the seller’s name in clear capital letters. Write it EXACTLY as it appears on the title, since the clerk matches this name against the title’s registered owner. Use full legal name, not initials or nicknames. Capital letters keep it legible.
For example, Maria Delgado prints MARIA ELENA DELGADO. The edge case is a recent legal name change; if your current name differs from the title, you may need supporting documents to bridge the gap. A common mistake is printing a married name when the title shows a maiden name, which creates a mismatch and a hold. People often assume the printed name is just a backup to the signature; the DOR actually treats it as the authoritative spelling for matching.
Field 11: Transferor’s Address (Street, City or Town, State, ZIP Code)
This block records where the seller lives. You enter the street address, city or town, state, and ZIP code in their separate boxes. Use your current mailing address, since the state may send notices there. Spell the city fully and use the two-letter state code, like MS.
For example, Earl Watkins writes 412 PINE ST, TUPELO, MS, 38801. The edge case is a P.O. Box; if that is your only mailing address, use it, but be ready to provide a physical address if the county asks. A common mistake is leaving the ZIP code blank, which can delay any mailed correspondence. Some filers think the address must match the title; it should reflect your current address, even if you have moved since the title was issued.
Field 12: Date of Statement
This field captures the date the seller signs the form, which should be the date of sale or transfer. You write it in month, day, year order, such as 06/06/2026. The date must be the day ownership actually changes, not a future or backdated day. A correct date keeps the disclosure valid.
For example, Dana Pruitt writes 06/06/2026 on the day she hands over the keys. The edge case is a sale that closes over two days, such as payment one day and pickup the next; use the day the title is signed over. The most serious mistake is backdating the form, which is a form of fraud and can void the sale. People sometimes leave this blank thinking it is optional; without a date, the disclosure can be treated as incomplete.
Field 13: Transferee’s Signature
Now the buyer signs to acknowledge the seller’s mileage certification. The buyer signs in blue or black ink in their own handwriting. By signing, the buyer confirms they received and accept the disclosed mileage. The buyer should sign only after reading the mileage and any checked discrepancy box.
For example, Robert Nguyen, the buyer, signs after reading that the odometer shows 87432. The edge case is two buyers taking joint ownership; both should sign if both names will go on the new title. A common mistake is leaving the buyer’s signature blank, which makes the disclosure one-sided and can get the title rejected. Many buyers think only the seller needs to sign; the law requires the buyer’s acknowledgment too.
Field 14: Transferee’s Printed Name
The buyer prints their full legal name in capital letters here, entered as it appears on the assignment of the manufacturer’s certificate of origin or title. This is the exact name that will appear on the new Mississippi title, so accuracy matters. Use full legal name, not a nickname. Capital letters keep it readable.
For example, Robert Nguyen prints ROBERT TAN NGUYEN. The edge case is a buyer who plans to title the car in a business name; enter the business’s exact legal name in that case. A common mistake is a typo in the buyer’s name, which carries straight onto the new title and registration. Some buyers assume they can fix the spelling later; correcting a name after titling is far harder than getting it right now.
Field 15: Transferee’s Address (Street, City or Town, State, ZIP Code)
The final block records where the buyer lives. The buyer enters street, city or town, state, and ZIP code in the separate boxes. This address becomes the registration address on the new title. Use a current, deliverable address.
For example, Robert Nguyen writes 77 MAPLE AVE, JACKSON, MS, 39201. The edge case is a buyer moving soon; use the address where they want the registration and tag notices sent. A common mistake is an incomplete address, such as a missing apartment number, which can delay the new title and tag. People often think the buyer’s address is minor paperwork; it actually controls where official vehicle mail goes for years.
Three Filled-Out Examples Using Real Scenarios
Below are three full walkthroughs, each following one named person through the whole form. Use them as models for your own situation.
Scenario 1: Standard Private Sale, Accurate Mileage
James Calhoun sells his clean 2018 Ford F-150 to a private buyer with the odometer reading honestly.
| Form Section | What James Enters |
|---|---|
| I, (Transferor’s Name) | JAMES ROBERT CALHOUN |
| Odometer Now Reads (No Tenths) | 87432 |
| Discrepancy Boxes (1) and (2) | Both left blank |
| Make | FORD |
| Model | F-150 |
| Body Type | PICKUP |
| VIN | 1FTEW1EP5JKD12345 |
| Year | 2018 |
| Transferor’s Signature / Printed Name | Signed / JAMES ROBERT CALHOUN |
| Transferor’s Address | 412 OAK DR, OXFORD, MS 38655 |
| Date of Statement | 06/06/2026 |
| Transferee’s Signature / Printed Name | Signed / ROBERT TAN NGUYEN |
| Transferee’s Address | 77 MAPLE AVE, JACKSON, MS 39201 |
Scenario 2: Older Vehicle Past Mechanical Limits (Box 1)
Earl Watkins sells a 1998 pickup whose five-digit odometer has rolled over, so the displayed number is far below true mileage.
| Form Section | What Earl Enters |
|---|---|
| I, (Transferor’s Name) | EARL DEAN WATKINS |
| Odometer Now Reads (No Tenths) | 12000 |
| Discrepancy Box (1) Mechanical Limits | Checked |
| Discrepancy Box (2) Not Actual Mileage | Blank |
| Make | CHEVROLET |
| Model | C/K 1500 |
| Body Type | PICKUP |
| VIN | 1GCEC14W0WZ123456 |
| Year | 1998 |
| Transferor’s Signature / Printed Name | Signed / EARL DEAN WATKINS |
| Transferor’s Address | 412 PINE ST, TUPELO, MS 38801 |
| Date of Statement | 06/06/2026 |
| Transferee’s Signature / Printed Name | Signed / LINDA FAYE BOOKER |
Scenario 3: Known Odometer Discrepancy / Broken Odometer (Box 2)
Dana Pruitt sells a 2015 sedan whose odometer broke and was replaced, so the current reading does not reflect true mileage.
| Form Section | What Dana Enters |
|---|---|
| I, (Transferor’s Name) | DANA MICHELLE PRUITT |
| Odometer Now Reads (No Tenths) | 31250 |
| Discrepancy Box (1) Mechanical Limits | Blank |
| Discrepancy Box (2) Not Actual Mileage | Checked |
| Make | HONDA |
| Model | ACCORD |
| Body Type | 4-DOOR SEDAN |
| VIN | 1HGCR2F3XFA123456 |
| Year | 2015 |
| Transferor’s Signature / Printed Name | Signed / DANA MICHELLE PRUITT |
| Transferor’s Address | 88 CEDAR LN, HATTIESBURG, MS 39401 |
| Date of Statement | 06/06/2026 |
| Transferee’s Signature / Printed Name | Signed / MARCUS LEE HOLLAND |
How to File the Completed Form
In most cases, the Odometer Disclosure Statement is not mailed by itself; it travels with the title transfer paperwork. You hand the original to the buyer along with the assigned title, and the buyer submits the package when applying for a new title and tag. Below are the channels available in Mississippi.
In person at the County Tax Collector. The most common route is for the buyer to take the assigned title, this form, and a bill of sale to the local County Tax Collector’s office. There is no separate fee for the disclosure statement itself, though title and registration fees apply, with the state title fee around $9 plus tag and tax costs. Pay by cash, check, or card per the county’s rules, expect same-day processing for the application, and keep your stamped copy as proof of filing.
By mail to Motor Vehicle Services. When a separate Form 78-015 is required, it can be mailed with the title work to Motor Vehicle Services, P. O. Box 1383, Jackson, MS 39215. Include the assigned title and any required affidavits, send by trackable mail, and allow several weeks for the new title to arrive. Keep a copy of everything and your mailing receipt as proof.
By fax for certain submissions. The DOR Motor Vehicle Services line lists a fax at 601-923-7224 for specific document needs; call 601-923-7200 first to confirm fax is accepted for your situation. Faxing gives you a transmission report as proof. Most buyers, though, will simply file in person at the county.
Whichever channel you use, never hand over your only copy. Make a photocopy or scan before submitting, because the disclosure is your shield if a mileage dispute ever surfaces.
What Happens After You File
Once the buyer submits the title application with the disclosure, the County Tax Collector and the Department of Revenue review the package. They cross-check the names, VIN, and mileage against their records. If everything matches, the state issues a new Certificate of Title in the buyer’s name, usually mailed within a few weeks. The disclosed mileage is recorded in the vehicle’s title history.
If a field is wrong or missing, the application is held or rejected. The buyer is then asked to fix the error, which may mean completing a corrected affidavit. A checked discrepancy box does not block the title; it simply gets noted as a not actual or exceeds mechanical limits brand on the title history, which follows the vehicle to future buyers.
For the seller, keeping a copy matters long after the sale. If the buyer later claims the mileage was wrong, your signed and dated disclosure is your proof of what the odometer read on the day you sold. For the buyer, the recorded mileage protects future resale value and guards against fraud claims. Both sides benefit from a clean paper trail.
Mistakes to Avoid When Filling Out the Form
Each error below has stopped a title or created legal risk for a filer.
- Writing the tenths of a mile. The form rejects fractions, and a number like 54219.8 can be read wrong and force a corrected affidavit.
- Using pencil or erasable ink. Non-permanent ink looks like tampering, and the clerk can refuse the document.
- Name not matching the title. A nickname or maiden name that differs from the title triggers a processing hold.
- Leaving the buyer’s signature blank. A one-sided disclosure is invalid and gets the title application rejected.
- A transposed VIN character. One wrong digit breaks the link to the title and forces a redo.
- Checking neither discrepancy box when one applies. Hiding a known mileage problem is a false statement that can void the sale.
- Backdating the date of statement. A false date is fraud and can invalidate the whole transfer.
- Entering the purchase year instead of the model year. This throws off the disclosure window and mismatches the title.
- Using correction fluid or cross-outs. Alterations on a mileage record draw scrutiny and can void the form.
- Confusing make and model boxes. Writing the model in the make box confuses the vehicle’s identity record.
- Leaving the ZIP code or address incomplete. Missing address parts delay the new title and tag.
- Writing on the title’s odometer block with errors. Any mistake there can void the entire Certificate of Title, not just the form.
Do’s and Don’ts
Do:
- Do read the odometer in person right before you sign, so the number is true.
- Do write in clear capital letters, because the clerk must match names exactly.
- Do copy the VIN one character at a time, since a single error voids the link.
- Do keep a photocopy for your records, because it protects you in a dispute.
- Do use blue or black ink only, so the document is accepted as permanent.
- Do check a discrepancy box when one applies, because honesty shields you from fraud claims.
Don’t:
- Don’t sign a blank or partial form, because you become liable for whatever is added later.
- Don’t backdate or postdate the form, since a false date is fraud.
- Don’t round the mileage up or down, because the sworn figure must be exact minus tenths.
- Don’t use a nickname, since it can stall the title match.
- Don’t use pencil or correction fluid, because both look like tampering.
- Don’t hand over your only copy, since you may need proof later.
Pros and Cons of Filing on Your Own vs. With Help
Most private sellers complete this form on their own, but some use a dealer, tag agent, or attorney. Here is how the choice breaks down.
Pros of filing on your own:
- It costs nothing beyond the standard title and tag fees, so you save service charges.
- You control the timing and can complete it the moment the sale closes.
- The form is short and plain, so a careful filer can finish it in minutes.
- You learn your own paperwork, which helps with future sales.
- You avoid sharing personal details with a third party.
Cons of filing on your own:
- A small error can cost you a trip back to the county tax collector.
- You carry full legal responsibility for every sworn entry.
- You may miss when a separate affidavit, like a corrected-title form, is needed.
- Discrepancy situations can be confusing without guidance.
- You have no professional to catch a VIN or name mismatch before submission.
How Form 78-015 Relates to Other Mississippi Title Forms
This disclosure does not work alone. When a name or mileage error appears on a title after the fact, Mississippi uses the Affidavit for Corrected Certificate of Title, Form 78-023, to fix the odometer record. When a third party is authorized to assign the title and disclose mileage, Mississippi provides the Authorization for Title Assignment and Mileage Disclosure, Form 78-033. Knowing which form fits your situation keeps the transfer on track, and the DOR form search lists all of them in one place. If you suspect odometer fraud, you can file a complaint with the Mississippi Attorney General Consumer Protection Division.
FAQs
Do I write the tenths of a mile in the odometer box?
No. The form says No Tenths, so drop any fraction. A reading of 54,219.8 is entered as 54219 in whole miles only.
Do both the buyer and the seller have to sign Form 78-015?
Yes. The seller signs to certify the mileage, and the buyer signs to acknowledge it. A missing buyer signature can get the title application rejected.
Do I need this form for a 2004 vehicle in 2026?
No. Federal disclosure covers vehicles up to 20 model years old, so a 2004 vehicle falls outside the window, though you may complete it for your own records.
Do I check a box if the odometer reading is honest and accurate?
No. Leave both discrepancy boxes blank when the mileage is true. You check a box only for a rollover or a known wrong reading.
Do I write my married name or my maiden name in the printed name box?
No. Write the name exactly as it appears on the title. If your name changed, you may need supporting documents to bridge the old and new names.
Do I have to use the official DOR form, or will any version work?
Yes. Use the official Mississippi Form 78-015, Rev. 09/17, so you have the current, accepted version with the correct fields.
Do I write the VIN in the year box by mistake often?
No. The VIN goes in its own 17-character box, and the year box takes only the four-digit model year, such as 2018.
Do I file this form by itself at the county office?
No. It travels with the assigned title and title application. The buyer submits the whole package to the County Tax Collector.
Do I owe a separate fee just for the disclosure statement?
No. There is no standalone fee for the form. Standard title and tag fees still apply to the overall transfer.
Do I have to record the buyer’s address on the form?
Yes. The buyer’s street, city, state, and ZIP go in the transferee block, because that becomes the registration address on the new title.
Do I need a separate form if the title already has an odometer block?
No. You may complete the odometer area on the back of the title instead, but read every title instruction first since any alteration can void it.
Do I face penalties for a false odometer statement?
Yes. Both federal and state law allow fines and possible imprisonment for false mileage statements, with federal penalties reaching up to $10,000 per violation.
Related reading
- How to Fill Out Alabama Odometer Disclosure Statement (w/Examples) + FAQs
- How to Fill Out the Arkansas DFA Odometer Disclosure Statement (Form 10-313) + FAQs
- How to Fill Out the Idaho ITD Odometer Disclosure Statement (w/ Examples) + FAQs
- How to Fill Out Mississippi DOR Application for Certificate of Title (Form 78-002) + FAQs
- How to Fill Out a Mississippi DOR Vehicle Bill of Sale (w/ Examples) + FAQs
- How to Fill Out the Mississippi DOR Vehicle Registration Application (Form 78-002) + FAQs
- How to Fill Out the South Dakota DMV Odometer Disclosure Statement + FAQs