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REORDER: TADASERVICES, HNIC,, 111 C)a Lavaca, SuiieWn, Aus&-,,TX <br />ODOMETER DISCLOSURE STATMEMELENT <br />Federal law (and State law, if applicable) requires that you state the mileage upon trans ierof <br />ownership. Failure to comelete o.r providing a false statement may result in fines and/or <br />imprisonment. <br />state that the odometer now <br />TRANSf-CHOR'SNANIS - PRINT) <br />reads (no tienihs) miles and to the best of my knovdedge that it reflects <br />the actual niteage of (hevehlclo doscribed below, unless one of the following statements is checked. <br />(1) 1 hereby cartiny that to the hesE of eery knowledge the odometer reading <br />0 reflects the amount of mileage In excess of its mechanical limits. <br />(2) 1 hereby certify that the odornerefr <br />reading is NOT the actual mileage, <br />WARNING ODOMETER DISCREPANCY, <br />MAKE <br />fI <br />BODY <br />MODE) <br />VEHICLE <br />IDENTIFICATION NUMBER <br />"'EAR <br />TRANSFE90R'S NAIME <br />(PRINTED NAME) <br />TRANSFEROR'S ADDRESS (STREET) <br />(Erry 1, (STATE) (ZIP CODE) <br />ER0q'S X <br />TRANSFL I NAME <br />SIGIIJATURE� <br />DATE OF STA IEbIEN-T <br />TRANSFEREE'S NAME <br />TRANSFEnEE S ADDRESS (S T R 0_7 T) <br />TRA!1JSFF­REE'5NAk4E X <br />(&GNATURF) <br />j ADA�_56 4/10 <br />