Bill of Sale and Odometer Disclosure Statement

Bill of Sale and Odometer Disclosure Statement
Department of Motor Vehicles 120 State Street

Agency of Transportation Montpelier, Vermont 05603-0001
802.828.2000
dmv.vermont.gov
If the vehicle being sold is 9 years old or newer and you are not submitting a separate Odometer Disclosure Statement,
please complete the Odometer Disclosure Statement on back of this form.
I / We (Seller(s) (If a company, give company name) hereby sell, assign or transfer
ownership of the vehicle or
vessel described below
Year Make Model Body/Hull Type Color Vessel Length
ft. in.
Vehicle/Vessel Identification Number (VIN/HIN) Odometer Reading (Vehicles only, no tenths)

 Miles  Kilometers
 Hours
New Owner New Co-Owner
to:
on: Date for: $
Has this vehicle failed an emissions test and been granted a time extension waiver in the past 12 months?  Yes  No
NOTE: A vehicle may not have two (2) consecutive time extension waivers. See avip.vermont.gov for more information.
If Vehicle is Salvage, Salvage and Rebuilt or Totaled this Section Must be Completed:
I/We certify the motor vehicle described above is:  Salvage  Salvage and Rebuilt  Declared a total loss by insurer
Any person who sells trades or offers for sale or trade any interest in a salvaged, salvaged and rebuilt or totaled vehicle shall disclose the fact that the vehicle has been salvaged
and rebuilt or totaled to a prospective purchaser both orally and in writing before a sale, trade or transfer is made. Written disclosure that the vehicle has been salvaged,
salvaged and rebuilt or totaled, in addition to being disclosed on the certificate of title as required by this subchapter, shall also be conspicuously disclosed on any bill of sale,
transfer, purchase or other agreement.
Failure of the seller to provide the notices required by this section shall result in the seller being required, at the option of the buyer, to refund to the buyer the purchase price,
including taxes, license fees and similar governmental charges. This information has been conveyed to the purchaser, both orally and in writing in accordance with 23 V.S.A.
Sections 2093 (b) (c), Salvaged, totaled and rebuilt vehicles. If this section is completed at least one new owner must sign:
Purchaser signature: Date:
The vehicle/vessel is free of all liens and encumbrances. Statements and warrants made herein are certified under penalty of
23 V.S.A. Sections 202, 203, 2082 & 3829 (4). If vehicle is jointly owned, both owners must sign.
Seller Signature - if company, Authorized Representative (include title) Date
Seller #1: Seller #2:
Seller Address
Seller Phone Number Seller email
Buyer Signature - if company, Authorized Representative (include title) Date
Buyer #1: Buyer #2:
Buyer Address
Buyer Phone Number Buyer email

Odometer Disclosure Statement
Odometer Disclosure Statement must be signed by both the buyer and seller. Failure to complete as requested will result in
return for completion.
An Odometer Disclosure Statement must be submitted for vehicles that are nine (9) years old and newer, self-propelled and
with a registered weight of 16,000 lbs or less.
Federal and State laws require that the Seller/Lessee disclose the mileage to the Buyer/Lessor in connection with the transfer
of ownership. An inaccurate statement, or failure to complete the statement, may result in fines and/or imprisonment, pursuant
to Section 409(a) of the Federal Motor Vehicle Information and Cost Savings Act of Public Law 92-513, and pursuant of
Vermont's Consumer Fraud Law.
Section 1 - Vehicle Information

Make Model Year Body Type Color
Vehicle/Vessel Identification Number
Section 2 - Odometer Disclosure

Federal and State law require that you furnish to the buyer a written odometer disclosure statement upon transfer of
ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment.
I certify that the odometer reading: (check one)
Reflects the actual mileage.
Reflects the mileage in excess of the odometer’s mechanical limits.

Enter odometer reading (no tenths)
Is not the actual mileage. Warning - Odometer Discrepancy
Section 3 – Seller/Transferor Information

Seller's name (print last, first, middle initial, or business name) Seller’s Phone Number
Seller's Address City State Zip
Seller’s Signature Date
Section 4 - Buyer Information

Buyer’s name (print last, first, middle initial, or business name) Buyer’s Phone Number
Buyer's Address City State Zip
Buyer’s Signature Date
Statements and warrants made herein are certified under penalty of 23 V.S.A. Sections 202,
203, 2082 & 3829 (4). If vehicle is jointly owned, only one (1) seller signature is required.
VT-005 01/2019 MTC

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Bill of Sale and Odometer Disclosure Statement

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Bill of Sale and Odometer Disclosure Statement

Department of Motor Vehicles 120 State Street

Vehicle/Vessel Identification Number (VIN/HIN) Odometer Reading (Vehicles only, no tenths)

on: Date for: $

Purchaser signature: Date:

Seller #1: Seller #2:

Seller Phone Number Seller email

Buyer Signature - if company, Authorized Representative (include title) Date

Buyer #1: Buyer #2:

Buyer Phone Number Buyer email

Section 1 - Vehicle Information

Vehicle/Vessel Identification Number

Section 2 - Odometer Disclosure

Reflects the mileage in excess of the odometer’s mechanical limits.

Section 3 – Seller/Transferor Information

Seller's Address City State Zip

Seller’s Signature Date

Section 4 - Buyer Information

Buyer's Address City State Zip

Buyer’s Signature Date

VT-005 01/2019 MTC

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