1. Vehicle
| Year / Make / Model | |
| VIN | |
| Licence plate | |
| Current odometer reading | miles |
2. Federal odometer disclosure
Federal law requires the transferor to state the mileage on transfer of ownership. Providing a false statement may result in fines or imprisonment. The odometer disclosure must also be completed on the Certificate of Title itself — this form records it but does not replace that requirement.
I certify that the odometer reading stated above is, to the best of my knowledge, the actual mileage of the vehicle, unless one of the following is checked:
- □ The mileage stated is in excess of its mechanical limits.
- □ The odometer reading is NOT the actual mileage. WARNING — ODOMETER DISCREPANCY.
- □ Exempt — the vehicle is of an age or class for which disclosure is not required.
3. Title and history
| Question | Answer |
| Is the title clean, or is it branded (salvage, rebuilt, junk, flood, lemon)? | |
| Has the vehicle been in a reported accident? | Yes / No / Unknown |
| Has the vehicle sustained frame or structural damage? | Yes / No / Unknown |
| Has the vehicle sustained flood, fire, or hail damage? | Yes / No / Unknown |
| Has the vehicle been used commercially (rideshare, delivery, taxi, rental)? | Yes / No / Unknown |
| Number of prior owners known to the Seller | |
| Is there any open safety recall known to the Seller? | Yes / No / Unknown |
| Vehicle history report provided to Buyer? | Yes / No — provider: |
The odometer disclosure must be signed by the Seller and acknowledged by the Buyer personally. A power of attorney must not be used to make the odometer disclosure on either Party’s behalf.
3.1 Smog, recalls and registration
| Item | Status |
| Valid smog certification provided (where required on transfer) | Yes / No / Exempt — date: |
| Registration current through | |
| Outstanding registration fees, tolls, or citations | None / Listed below: |
| Open safety recalls checked against the VIN | Yes / No — result: |
| NMVTIS or equivalent title history checked | Yes / No — date: |
4. Known defects disclosed by the Seller
The Seller must list every material defect known to them. Silence about a known defect is a misrepresentation.
| System | Condition / known issues |
|---|---|
| Engine | |
| Transmission | |
| Brakes | |
| Suspension and steering | |
| Electrical and electronics | |
| Air conditioning and heating | |
| Hybrid or EV battery, if applicable | |
| Tyres and wheels | |
| Body, glass, and paint | |
| Interior | |
| Warning lights currently illuminated | |
| Other |
5. Buyer inspection
| Did the Buyer test drive the vehicle? | Yes / No |
| Was an independent mechanical inspection performed? | Yes / No |
| If no, the Buyer declined the opportunity | Buyer initials: |
| Inspection report attached? | Yes / No |
6. As-is sale
THIS VEHICLE IS SOLD AS-IS, WITHOUT ANY WARRANTY. The Buyer assumes responsibility for repairs and maintenance from the date of sale. The Seller makes no warranty of merchantability or fitness for a particular purpose.
This as-is sale does not excuse the Seller from the accuracy of the disclosures made in this document, does not cover fraud or concealment of a known defect, and does not waive any right the Buyer holds under California law that cannot lawfully be waived.
If the Seller is a licensed dealer rather than a private individual, additional obligations apply, including a written buyer’s guide and any cancellation option required by law. Sellers who are licensed dealers must not use this form alone.
7. Signatures
The Seller certifies that the disclosures above are true and complete to the best of the Seller’s knowledge. The Buyer acknowledges receiving this disclosure before signing the sale agreement.
Seller signature: Date:
Print name:
Buyer signature: Date:
Print name: