State Form 43230 at a glance
What it is: State Form 43230 (R5 / 4-26) is the Odometer Disclosure Statement of the Indiana Bureau of Motor Vehicles.
Who signs: The disclosure must be signed by the seller, including the printed name. If more than one person is a seller, only one seller is required to sign the written disclosure. The purchaser must sign the disclosure statement, including printed name and address, and return a copy to the seller.
In accordance with federal and state law, the seller of a motor vehicle must disclose the current mileage to a purchaser in writing upon transfer of ownership.
A filled-in State Form 43230 example: a seller and a purchaser complete the statement
How to fill out State Form 43230, box by box
Seller(s) name and address
Enter the Printed name(s) of Seller(s) after I, and the Address of Seller(s) (number and street, city, state, and ZIP code) after residing at.
Odometer reading and statements
The seller certifies to the best of the seller's knowledge that the odometer reading is the actual mileage of the vehicle described in the Vehicle Make, Vehicle Model, Vehicle Year, Vehicle Body Type and Vehicle Identification Number (VIN) boxes unless one of the following statements is checked.
Enter the Miles (no tenths).
Box 1 reads: "I hereby certify that to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits."
Box 2 reads: "I hereby certify that the odometer reading is NOT the actual mileage and should not be relied upon. WARNING, ODOMETER DISCREPANCY."
Federal and State law requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false statement may result in fines, imprisonment, or both.
Vehicle and transfer date
Enter the Vehicle Make, Vehicle Model, Vehicle Year and Vehicle Body Type.
Enter the Vehicle Identification Number (VIN) and the Transfer Date (mm/dd/yyyy).
Signature(s) of Seller(s)
I will not hold the Bureau of Motor Vehicles or the Bureau of Motor Vehicles Commission responsible for any discrepancy shown on the odometer reading. I, the undersigned, swear or affirm that the information entered on this form is correct. I understand that making a false statement may constitute the crime of perjury.
Sign the Signature(s) of Seller(s) line and enter the Date (mm/dd/yyyy).
The disclosure must be signed by the seller, including the printed name.
If more than one person is a seller, only one seller is required to sign the written disclosure.
Purchaser's information
The purchaser is aware of and acknowledges the odometer certification made by the seller(s).
Sign the Signature(s) of Purchaser(s) line and enter the Date (mm/dd/yyyy).
Enter the Printed Name(s) of Purchaser(s), the Address of Purchaser(s) (number and street), and the City, State and ZIP Code.
The purchaser must sign the disclosure statement, including printed name and address, and return a copy to the seller.
Before you go
Complete this form in its entirety, in blue or black ink.
Sources
[1] State Form 43230 (R5 / 4-26), Odometer Disclosure Statement, Indiana Bureau of Motor Vehicles (the Official source link on this page).