Fillable Printable Vehicle Bill of Sale Form - Mississippi

Vehicle Bill of Sale Form - Mississippi

I, STATE THAT THE ODOMETER NOW READS (NO TENTHS)

MILES AND TO THE BEST OF MY KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE

DESCRIBED BELOW, UNLESS ONE OF THE FOLLOWING STATEMENTS IS CHECKED:

BOTH FEDERAL LAW AND STATE LAW REQUIRE THAT YOU (THE TRANSFEROR) STATE THE MILEAGE IN

CONNECTION WITH THE TRANSFER OF OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE

STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.

(1) I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING REFLECTS

THE AMOUNT OF MIELAGE OF THE VEHICLE IN EXCESS OF THE ODOMETER'S MECHANICAL

LIMITS.

TRANSFEREE'S

ADDRESS

PRINTED NAME

STREET CITY OR TOWN

DATE OF STATEMENT

PRINTED NAME

TRANSFEREE'S NAME

ENTER NAME AS IT APPEARS ON THE ASSIGNMENT OF MGFR'S. CERTIFICATE OF ORIGIN,OR TITLE

TRANSFEROR'S ADDRESS

(2) I HEREBY CERTIFY THAT THE ODOMETER READING IS

NOT

THE ACTUAL MILEAGE.

WARNING

- ODOMETER DISCREPANCY

MAKE MODEL BODY TYPE

VEHICLE

IDENTIFICATION NUMBER

YEAR

STATE

TRANSFEREE'S SIGNATURE

ZIP CODE

TRANSFEROR'S SIGNATURE

STREET CITY OR TOWN STATE ZIP CODE

ODOMETER DISCLOSURE STATEMENT

Form 78-015-10-1-1-000

Title Bureau, P. O. Box 1383, Jackson, MS 39215 www.dor.ms.gov Phone 601-923-7200 Fax 601-923-7224