Date of Transfer
Date of Sale / Transfer: [[Date of Sale or Transfer]]
Seller Information
SELLER
Full Legal Name: [[Seller Full Legal Name]]
Address: [[Seller Street Address]], [[Seller City]], Washington [[Seller ZIP Code]]
Phone: [[Seller Phone Number]]
Email: [[Seller Email Address]]
Buyer Information
BUYER
Full Legal Name: [[Buyer Full Legal Name]]
Address: [[Buyer Street Address]], [[Buyer City]], [[Buyer State]] [[Buyer ZIP Code]]
Phone: [[Buyer Phone Number]]
Email: [[Buyer Email Address]]
Vehicle Identification
| Field | Value |
|---|
| Year | [[Vehicle Year]] |
| Make | [[Vehicle Make]] |
| Model | [[Vehicle Model]] |
| Body Style / Type | [[Vehicle Body Style]] |
| VIN | [[Vehicle Identification Number]] |
| Title Number / State | [[Title Number]] / Washington |
Odometer Reading at Time of Transfer
Odometer Reading: [[Odometer Reading]] miles
Date Odometer Read: [[Odometer Reading Date]]
Odometer Certification
The seller certifies under penalty of law that the odometer reading is accurate to the best of the seller's knowledge. Select one:
- The odometer reading reflects the actual mileage.
- The odometer reading reflects the mileage in excess of the designed mechanical limits of the odometer (odometer rolled over).
- The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY.
Seller's explanation for any discrepancy (if applicable): [[Explanation of Odometer Discrepancy or "None"]]
Federal and State Requirements
- This disclosure is required by federal law (49 U.S.C. § 32705 and 49 CFR Part 580) for most motor vehicles.
- The disclosure must be made at or before the time of transfer of ownership.
- Exemptions include vehicles 20 model years old or older and vehicles with a gross vehicle weight rating over 16,000 pounds.
- Washington DOL requires accurate odometer information to process title applications and issue new titles.
- Knowingly providing false information on this statement is a federal offense and may also violate Washington law.
- The buyer should retain a copy of this disclosure with the title documents.
- Sellers must provide the disclosure in writing; verbal statements are insufficient.
Penalties for Non-Compliance or False Statements
- Federal civil penalties may include fines up to $10,000 per violation (subject to adjustment).
- Criminal penalties may apply for willful violations including fines and imprisonment.
- Washington may impose additional administrative sanctions or deny title transfer.
- Buyers may have private right of action for damages caused by inaccurate disclosure.
- Always retain copies of signed disclosure for at least five years.
Signatures and Acknowledgment
SELLER CERTIFICATION AND SIGNATURE
I certify that the information provided above is true and correct to the best of my knowledge.
Signature: _______________________________ Date: [[Date]]
Printed Name: [[Seller Full Legal Name]]
BUYER ACKNOWLEDGMENT AND SIGNATURE
I acknowledge receipt of this odometer disclosure statement.
Signature: _______________________________ Date: [[Date]]
Printed Name: [[Buyer Full Legal Name]]
WITNESS (Optional but Recommended)
Signature: _______________________________ Date: [[Date]]
Printed Name: [[Witness Full Legal Name]]
Additional Attachments and Supporting Documents
- Copy of current title or application for title
- Previous odometer disclosure (if any)
- Repair or maintenance records affecting odometer (if relevant)
- [[Other Attachments or Documents]]
Expanded Guidance and Best Practices
- Read the odometer directly from the vehicle dashboard before completing this form.
- Compare the odometer reading against service records and prior disclosures.
- If the vehicle has a digital odometer, note any tampering indicators or error messages.
- Complete this form in ink or via secure electronic signature where accepted.
- Provide the buyer with the original signed copy before or at delivery.
- Keep a duplicate for your records and for DOL submission.
- Verify that the VIN on the disclosure matches the vehicle and title exactly.
- Disclose any known issues with the odometer or mileage history in the explanation field.
- For leased vehicles returning to lessor, ensure the lessor receives the disclosure.
- Confirm the current model year cutoff for exemptions with the Washington DOL before transfer.
- Photograph the dashboard odometer and VIN plate at time of transfer for your records.
- If selling out of state, provide this disclosure along with any additional state forms required by the destination.
- Consult the Washington DOL website or local office for the most current procedures as of June 2026.
- Coordinate with any lienholder to ensure title is clear before final transfer.
- Retain all documents for tax, warranty, and potential dispute resolution purposes.
Sources and Disclaimer
This statement is designed to comply with the federal Truth in Mileage Act (49 U.S.C. § 32705) and 49 CFR Part 580, as well as Washington Department of Licensing titling requirements. Odometer disclosure rules were updated in 2021 to extend coverage to vehicles up to 20 model years old.
Requirements and penalties are subject to change. Confirm the latest rules, forms, fees, and procedures directly with the Washington State Department of Licensing (DOL) as of June 2026.
⚠️ Template example - not professional legal advice. This document does not constitute legal counsel. Consult a qualified attorney licensed in Washington and verify all information with the Washington DOL before using or relying on this form. Figures, disclosures, and procedures must be verified for the specific transaction and jurisdiction. Invented values appear as [[Merge Fields]] and must be replaced with actual information.
As of: June 2026
End of Washington Odometer Disclosure Statement
