#2070
@001 Enter the name of the SELLER of the vehicle:
@201 Enter SELLER's street address:
@202 Enter SELLER's city, state- zip code:
@002 Enter BUYER's name:
@300 Enter BUYER's street address:
@301 Enter BUYER's city, state- zip code:
@100 Enter the number of miles/kilometers on odometer:
@101/@101 Odometer reads:
miles
kilometers
@102 Enter make of automobile:
@103 Enter model of automobile:
@104/@104/@104/@104 Enter body type:
2 door
4 door
Station Wagon
KEY IN VALUE
@105 Enter year of make:
@106 Enter vehicle identification number:
#end control section
#2070
/* Para. 2070: Federal regulations- Odometer statement*/


                    ODOMETER MILEAGE STATEMENT



IMPORTANT: Federal regulations require this statement to be given 
to purchasers on sales of vehicles. An inaccurate or untrue 
statement may make you liable for damages to the buyer and there 
may also be civil or criminal penalties.


@001, state that the odometer described below now reads @100 @101.



Certify one of the following-- please "XXX" the appropriate line 
before the correct statement:




___________ I (we) certify that to the best of my (our) knowledge 
the odometer reading as stated above reflects the actual mileage 
of the vehicle described below.



___________ I (we) certify that to the best of my (our) knowledge 
the odometer reading as stated above reflects the amount of 
mileage in excess of designed mechanical limits of 99,999 @101 of 
the vehicle described below.



___________ I (we) certify that to the best of my (our) knowledge 
the odometer reading as stated above is NOT the actual mileage of 
the vehicle described below, and should not be relied upon.



MAKE: @102


MODEL @103


BODY TYPE @104


YEAR: @105


VEHICLE IDENTIFICATION NUMBER: @106



Certify one of the following-- please "XXX" the appropriate line 
before the correct statement:



__________ I (we) certify that the odometer of the vehicle 
described above was not altered, set back, or disconnected while 
in my (our) possession, and I (we) have no knowledge of anyone 
else doing so.



__________ I (we) certify that the odometer was alerted for repair 
or replacement purposes while in my (our) possession, and that the 
mileage registered on the repaired or replaced odometer is 
identical to that before such service.



__________ I (we) certify that if the repaired or replacement 
odometer was incapable of registering the same mileage, that it 
was reset to zero, and that the mileage on the original odometer 


or the odometer before repair was __________________ @101.




SELLER (Transferor) address:


@201

@202


Date of statement: ___________________________






___________________________________________________

@001



BUYER (Transferee) name and address:



@002

@300

@301





Receipt of copy acknowledged:






____________________________________________

@002