Free BDVR-108 MDOS Odometer Mileage Statement - Michigan

www.Michigan.gov/sos

ODOMETER MILEAGE STATEMENT
(See Reverse Side for Leased Vehicles)

MICHIGAN DEPARTMENT OF STATE

Clear Form

Federal law and section 233a of the Michigan Vehicle Code require that you state the mileage in connection with the transfer of ownership. Failure to complete or providing false statement may result in civil liability, fines and/or imprisonment.
Year Body Style Make Vehicle Identification Number Model

I (we) certify that the odometer reading is: And certify that to the best of my knowledge the odometer mileage is:

(No Tenths)

Check One

actual mileage not actual mileage - WARNING - ODOMETER DISCREPANCY exceeds mechanical limits of odometer (5-digit odometer has rolled over)

* *

Note: Mileage cannot be corrected at a later date.

Name of Seller(s) (Please Print) Address City Signature(s) of Seller(s) State Zip Code Date

X

Name of Purchaser(s) (Please Print) Address City State Zip Code

"I am aware of the above odometer certification made by the seller(s)."
Signature(s) of Purchaser(s) Date

X

BDVR-108 (09/07)

Authority granted under Public Act 300 of 1949 as amended.

www.Michigan.gov/sos

ODOMETER MILEAGE STATEMENT
Leased Vehicles ONLY

MICHIGAN DEPARTMENT OF STATE

Clear Form

Federal law and section 233a of the Michigan Vehicle Code require that a lessee disclose the mileage to the lessor in connection with the transfer of ownership. Failure to complete or providing false statement may result in civil liability, fines and/or imprisonment.
Year Body Style Make Vehicle Identification Number Model

I (we) certify that the odometer reading is: And certify that to the best of my knowledge the odometer mileage is:

(No Tenths)

Check One

actual mileage not actual mileage - WARNING - ODOMETER DISCREPANCY exceeds mechanical limits of odometer (5-digit odometer has rolled over)
Note: Mileage cannot be corrected at a later date.

* *

Name of Lessee(s) (Please Print) Address City Signature(s) of Lessee(s) State Zip Code Date

X

Name of Lessor (Please Print) Address City Date Statement Sent to Lessee State Date Received from Lessee Zip Code

Name of Lessor's Agent (Please Print) Signature of Agent Date

X

BDVR-108 (09/07)

Authority granted under Public Act 300 of 1949 as amended.