1. Vehicle Identification
- Year: [[Vehicle Year]].
- Make: [[Vehicle Make]].
- Model: [[Vehicle Model]].
- Body style: [[Body Style]].
- VIN: [[VIN]].
- Current license plate (if applicable): [[Plate Number, State]].
2. Odometer Reading at Transfer
- Odometer reading shown on the vehicle at time of transfer: [[Odometer Reading]] miles.
- The reading above (check one):
- Reflects the actual mileage traveled by the vehicle.
- Does not reflect the actual mileage because the odometer reading is known to be different from the actual mileage (discrepancy).
- Reflects the mileage in excess of the odometer's mechanical limits (the odometer has rolled over).
- If exempt, mark here and write "EXEMPT" in the mileage field: The vehicle qualifies for exemption from odometer disclosure requirements.
3. Federal Odometer Disclosure Requirements
- This disclosure is made pursuant to 49 U.S.C. § 32705 (Truth in Mileage Act) and 49 C.F.R. Part 580.
- Effective with 2021 model year changes, odometer disclosure is required for vehicles less than twenty (20) model years old at the time of transfer. Vehicles twenty (20) model years old and older are generally exempt.
- Exemptions also include vehicles with a gross vehicle weight rating (GVWR) over 16,000 pounds and certain other categories per federal regulation.
- Seller must disclose the mileage reading or exemption status accurately on the title or secure power of attorney or equivalent when title is not immediately available.
- Buyer must acknowledge the disclosure by signing.
4. Seller Certification
- I, [[Seller Full Name]], certify under penalty of perjury that the odometer reading stated above is true and accurate to the best of my knowledge and belief.
- I further certify that I am the registered owner or authorized transferor and that I have not altered or tampered with the odometer.
- Any false statement may result in civil and criminal penalties under federal law (up to fines and imprisonment) and Georgia law.
Seller signature: _____________________________________________ Date: [[Date]]
Printed name: [[Seller Full Name]]
5. Buyer Acknowledgment
- I, [[Buyer Full Name]], acknowledge that I have reviewed the odometer reading and any disclosures made by the seller.
- I understand that the odometer reading may not be accurate if the discrepancy or exceeds limits box is checked.
- I accept the vehicle with the mileage as disclosed.
Buyer signature: _____________________________________________ Date: [[Date]]
Printed name: [[Buyer Full Name]]
6. Georgia Title Transfer Integration
- This disclosure accompanies the bill of sale and title documents for submission to the Georgia county tag office.
- Georgia requires odometer information on the secure title document or approved form during transfer of ownership.
- For vehicles exempt due to age (20+ model years), the word "EXEMPT" or appropriate notation must be entered in the odometer field on the title application or reassignment.
- Dealers must retain odometer records for five (5) years.
- When a Georgia certificate of title is required (generally 1986 and newer passenger vehicles and certain others), the odometer disclosure is captured as part of the titling process.
7. Penalties for Non-Compliance or False Statements
- Federal penalties for odometer fraud include fines up to $10,000 per violation and imprisonment.
- Georgia may impose additional civil penalties, title rejection, or other sanctions for inaccurate disclosures.
- Both parties should retain copies of this signed statement with all transfer paperwork.
8. Additional Notes and Instructions
- Complete this form legibly in ink or electronically with verifiable signatures.
- Attach to or reference on the bill of sale and title documents.
- If the title is held by a lienholder, a secure power of attorney or dealer reassignment may be used to convey the odometer disclosure.
- For leased vehicles returning to lessor, lessor disclosures follow the same federal standards.
- Update the model year calculation accurately: a 2007 model year vehicle in 2026 is 19 model years old and still requires disclosure; a 2006 is 20 years old and exempt.
> ⚠️ Template - not professional (legal/financial/medical) advice. Verify the current model year cutoff, exemption rules, and Georgia DOR MVD procedures as of the transfer date. [[Seller Full Name]], [[Buyer Full Name]], [[Odometer Reading]], [[VIN]], and other tokens are user-supplied placeholders. False odometer disclosures carry serious federal and state penalties. Consult official sources and professionals for your transaction.
Primary Sources (as of June 2026):
- Georgia DOR Odometer Disclosure Information: dor.georgia.gov/odometer-disclosure-information-0
- 49 U.S.C. § 32705 and 49 C.F.R. Part 580 (federal odometer rules, 20-year exemption)
- Georgia MVD title transfer forms and T-7 bill of sale guidance
- NHTSA odometer disclosure updates effective 2021
- Confirm the vehicle's model year against the 20-year exemption threshold before checking exempt.
- Use the exact odometer reading shown on the dashboard at transfer; do not estimate.
- Both seller and buyer must sign; keep original with title documents.
- If using Georgia Form T-7 or MV-1, ensure odometer fields match this disclosure.
- For questions on secure documents when title is unavailable, contact the county tag office or Georgia DOR MVD.
- Retain records: sellers (especially dealers) must keep declarations for the required period.
