Form 3019 PDF Details

In the realm of vehicle transactions, accurate record-keeping plays a pivotal role, chiefly when it concerns the disclosure of a vehicle's mileage. The 3019 form, issued by the Missouri Department of Revenue Motor Vehicle Bureau, serves as a fundamental document in this process. This official form is a mandated tool ensuring transparency during the ownership transfer of motor vehicles, stipulating that both buyers and sellers accurately state the vehicle's odometer reading. Its meticulous completion becomes a legal responsibility, with failure to comply or providing fraudulent information potentially leading to severe penalties, including fines or imprisonment. The form itself encompasses various fields including year, make, vehicle identification number (VIN), title number, and, significantly, the odometer reading without rounding to the nearest tenth. It also accommodates situations where there may be discrepancies in the odometer reading, with specific provisions for indicating whether the mileage exceeds mechanical limits or if the odometer reading is not an accurate reflection of the actual mileage. For transactions involving an agent or officer of a firm, additional details regarding the official position are required. Furthermore, it underscores the requirement for a physical attachment of this disclosure to the certificate of title or manufacturer’s statement of origin if existing documents fail to meet set federal criteria, thereby ensuring continuous adherence to legal standards in vehicle transaction documentation.

QuestionAnswer
Form NameForm 3019
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesodometer disclosure statement form, federal odometer disclosure statement, federal odometer statement form, odometer statement template

Form Preview Example

 

MISSOURI DEPARTMENT OF REVENUE

 

 

Federal law (and State law, if

 

MOTOR VEHICLE BUREAU

FORM

 

applicable) requires that you state

 

ODOMETER DISCLOSURE

3019

 

the mileage upon transfer of

 

STATEMENT

ownership. Failing to complete or

 

 

 

 

(REV. 11-2005)

providing a false statement may

INSTRUCTIONS ON REVERSE

result in fines and/or imprisonment.

 

YEAR

 

MAKE

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

 

TITLE NUMBER

STATE

MODEL

BODY STYLE

If purchaser/seller is an agent/officer of a firm, record official position after printed name. The purchaser/seller should retain a copy of this odometer disclosure statement. If “Warning, Odometer Discrepancy” is checked, the seller must attach a statement explaining all facts regarding the discrepancy.

PURCHASER(S) NAME

(PRINTED OR TYPED)

ADDRESS

DATE

SELLER(S) (FIRM) NAME

(PRINTED OR TYPED)

ADDRESS

DEALER NO.

ODOMETER READING

(NO TENTHS)

I state that the odometer now reads the aforementioned miles and to the best of my knowledge that it reflects the actual mileage of the vehicle described herein, unless one of the following statements is checked.

Mileage in excess of its mechanical limits Mileage reading not actual

(WARNING, ODOMETER DISCREPANCY)

SIGNATURE OF PURCHASER(S)

SIGNATURE OF SELLER(S)

HAND PRINTED NAME(S) BY PURCHASER(S)

HAND PRINTED NAME(S) BY SELLER(S)

PURCHASER(S) NAME

(PRINTED OR TYPED)

ADDRESS

DATE

SELLER(S) (FIRM) NAME

(PRINTED OR TYPED)

DEALER NO.

ADDRESS

ODOMETER READING

I state that the odometer now reads the aforementioned miles and to the

 

Mileage in excess of its mechanical limits

(NO TENTHS)

best of my knowledge that it reflects the actual mileage of the vehicle

 

 

Mileage reading not actual

 

 

 

 

described herein, unless one of the following statements is checked.

 

 

(WARNING, ODOMETER DISCREPANCY)

 

 

 

SIGNATURE OF PURCHASER(S)

SIGNATURE OF SELLER(S)

HAND PRINTED NAME(S) BY PURCHASER(S)

HAND PRINTED NAME(S) BY SELLER(S)

PURCHASER(S) NAME

(PRINTED OR TYPED)

ADDRESS

DATE

SELLER(S) (FIRM) NAME

(PRINTED OR TYPED)

DEALER NO.

ADDRESS

ODOMETER READING

I state that the odometer now reads the aforementioned miles and to the

 

Mileage in excess of its mechanical limits

(NO TENTHS)

best of my knowledge that it reflects the actual mileage of the vehicle

 

Mileage reading not actual

 

 

 

described herein, unless one of the following statements is checked.

 

(WARNING, ODOMETER DISCREPANCY)

 

 

SIGNATURE OF PURCHASER(S)

SIGNATURE OF SELLER(S)

HAND PRINTED NAME(S) BY PURCHASER(S)

HAND PRINTED NAME(S) BY SELLER(S)

PURCHASER(S) NAME

(PRINTED OR TYPED)

ADDRESS

DATE

SELLER(S) (FIRM) NAME

(PRINTED OR TYPED)

DEALER NO.

ADDRESS

ODOMETER READING

I state that the odometer now reads the aforementioned miles and to the

 

Mileage in excess of its mechanical limits

(NO TENTHS)

best of my knowledge that it reflects the actual mileage of the vehicle

 

Mileage reading not actual

 

 

 

described herein, unless one of the following statements is checked.

 

(WARNING, ODOMETER DISCREPANCY)

 

 

SIGNATURE OF PURCHASER(S)

SIGNATURE OF SELLER(S)

HAND PRINTED NAME(S) BY PURCHASER(S)

HAND PRINTED NAME(S) BY SELLER(S)

MO 860-2086 (11-2005)

DISTRIBUTION: WHITE—ATTACH TO MSO OR CERT. OF TITLE

When a certificate of title or a manufacturer’s statement of origin does not meet the federal requirements for a proper odometer disclosure, a separate odometer disclosure statement must be issued by the seller and attached to the certificate of ownership at the time of transfer of a motor vehicle.

The following vehicles are exempt from the odometer requirements:

1.Any motor vehicle that is ten years old or older;

2.Any motor vehicle having a gross vehicle weight rating of more than 16,000 pounds; and

3.Any new motor vehicle transferred from one franchise dealer to another.

If the Missouri title was issued after August 28, 1989, the odometer disclosure is required to be completed on the back of the title rather than on a separate disclosure statement.

COMPLETING THE ODOMETER DISCLOSURE STATEMENT

1.All information on the disclosure statement can be typed or computer generated except for the printed names and signatures of the purchaser(s) and seller(s).

2.One purchaser and one seller must sign the form.

3.One purchaser and one seller must hand print their name.

4.The seller must state the exact mileage as listed on the odometer at the time of transfer, excluding tenths. If there is a discrepancy in the number of miles shown, one of the mileage blocks must be checked:

Mileage in Excess of Mechanical Limits — If the actual mileage of the vehicle is 125,000 but only 25,000 is shown on the odometer, the seller must insert 25,000 in the odometer reading area and check the box stating Mileage in Excess of Mechanical Limits.

Mileage Reading Is Not Actual — If the true mileage is different from the mileage shown on the odometer or the true mileage is unknown, the seller must submit a statement explaining all facts concerning the true mileage versus the mileage shown on the odometer.

MAKING CORRECTIONS ON ODOMETER DISCLOSURE STATEMENTS

If an error should occur when completing the second, third, or fourth odometer disclosure space on the Odometer Disclosure Statement, the seller should:

1.Draw a large “X” in that disclosure space;

2.Make the correct disclosure in the next disclosure space;

3.Ensure that the purchaser and seller complete and sign a statement explaining the error and attach it to the odometer disclosure statement.

NOTE: Both documents must accompany the application for title.

If the error is made while completing the fourth disclosure space, a new odometer disclosure statement should be attached to the original disclosure statement, accompanied by the statement explaining the error.

Web site address: www.dor.mo.gov/mvdl

MO 860-2086 (11-2005)

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Best ways to fill in odometer statement template step 1

2. Immediately after the last selection of fields is completed, proceed to enter the relevant details in all these - ODOMETER READING NO TENTHS, I state that the odometer now, Mileage in excess of its, SIGNATURE OF PURCHASERS, SIGNATURE OF SELLERS, HAND PRINTED NAMES BY PURCHASERS, HAND PRINTED NAMES BY SELLERS, PURCHASERS NAME PRINTED OR TYPED, ADDRESS, SELLERS FIRM NAME PRINTED OR TYPED, ADDRESS, ODOMETER READING NO TENTHS, DATE, DEALER NO, and I state that the odometer now.

ADDRESS, I state that the odometer now, and SIGNATURE OF SELLERS of odometer statement template

It is easy to make errors while filling out your ADDRESS, so ensure that you take another look before you decide to send it in.

3. Throughout this step, examine SIGNATURE OF PURCHASERS, SIGNATURE OF SELLERS, HAND PRINTED NAMES BY PURCHASERS, HAND PRINTED NAMES BY SELLERS, and DISTRIBUTION WHITEATTACH TO MSO OR. Every one of these should be completed with utmost attention to detail.

odometer statement template writing process detailed (step 3)

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