DMV Bill of Sale Form - Vermont
Bill of Sale and O dometer Disclos ure Statement
Department of Motor Vehicles
Agency of Transportation
120 State Street
Montpe li e r , Ve rmont 05603-0001
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 transf er owners h ip of the vehicle / ves sel des cr ibe d belo w:
Vehicle/Vessel Identification Number (VIN/HIN)
Odometer Reading (Vehicles only, no tenths)
IF VEHICLE IS SALVAGE, SALVAGE AND REBUILT OR TOTALED THIS SECTION MUST BE COMPLETED:
I/We also certify that the motor vehicle described above is:
Salvage Salvaged 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 writ
ing 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 dis
closed on any bill of sale,
transfer , purch ase or other a g r eement.
Fai l ur e of t he s eller to provide the no t i c e s r equire d by this s ectio n shall r esult i n t he seller being r e quired, at the o ptio
n of the buyer , t o r efund to the buyer the purchase price,
includin g taxes, li cense f ees 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's sign atu re:
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's Signat ure - if com pany, Authorized Repres ent ative (include title)
Seller's A ddress
Seller’s Phone Number
Buyer’s Signature - if company, Authorized Representative (include titl e)
Buyer’s Phone Number & email
VT-005 07/2017 MTC
Odometer Disclosure S t ate m e nt
Odometer Disclosure Statement must be signed by both the buyer and seller. Failure to complete as requested will result in
return for completion.
An Odom eter Disc losure St atement m ust be s ubmitted f or vehicles t hat are n ine (9) years old and n ewer, se lf -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
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.
Enter odometer reading (no tenths)
Reflects the mileage in excess of the odometer’s mechanical lim its.
Is not the actual mileage. Warning - Odometer Discrepancy
Section 3 – Seller/Transferor Infor mation
Seller's name (print l ast, first, middl e i ni tial , or bus i ness name)
Seller’s Phone Number
Seller's A ddress
Seller’s Signat ure
Section 4 - Bu yer Information
Buyer’s name (print last, fi rst, middle initial, or business name)
Buyer’s Phone Number
Statements and warrants made herein are certified under penalty of 23 V.S.A. Sections 202,
203, 2082 & 3829 (4). If vehicle i s jointly owned, only one (1) seller signature is re quired.