Form 3019: Missouri Odometer Disclosure Statement

Enter the year, make, vehicle identification number, title number, state, model and body style.

Enter the PURCHASER(S) NAME (PRINTED OR TYPED), the DATE and the ADDRESS.

Enter the SELLER(S) (FIRM) NAME (PRINTED OR TYPED), the DEALER NO. and the ADDRESS.

Under ODOMETER READING (NO TENTHS), the seller must state the exact mileage as listed on the odometer at the time of transfer, excluding 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.

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.

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.

One purchaser and one seller must sign the form, under SIGNATURE OF PURCHASER(S) and SIGNATURE OF SELLER(S).

One purchaser and one seller must hand print their name, under HAND PRINTED NAME(S) BY PURCHASER(S) and HAND PRINTED NAME(S) BY SELLER(S).

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).

The following vehicles are exempt from the odometer requirements: Model year 2010 or older and at least ten years of age at the time of ownership transfer. Model year 2011 or newer and at least twenty years of age at the time of ownership transfer. Any motor vehicle having a gross vehicle weight rating of more than 16,000 pounds. 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.

If an error should occur when completing the second, third, or fourth odometer disclosure space on the Odometer Disclosure Statement, the seller should: Draw a large “X” in that disclosure space. Make the correct disclosure in the next disclosure space. Ensure that the purchaser and seller complete and sign a statement explaining the error and attach it to the odometer disclosure statement. 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.

Federal law (and State law, if applicable) requires that you state the mileage upon transfer of ownership: failing to complete or providing a false statement may result in fines and/or imprisonment.