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Vermont Motor Vehicle Bill of Sale Form

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The Vermont motor vehicle bill of sale form is a legal document provided by Vermont Department of Motor Vehicles for the transfer of the motor vehicle.

Vermont Motor Vehicle Bill of Sale Form Page 2
Vermont Motor Vehicle Bill of Sale Form
TA-VT-05 50M 07/2012 REB Vermont Telecommunications Relay Service Dial 711
Odometer Disclosure Statement
Odometer Disclosure Statement must be signed by both
the buyer and seller. Failure to complete as requested will result
in return for completion.
An Odometer Disclosure Statement must be submitted for vehicles that are nine (9) years old and newer, self-propelled and
with a registered weight of 16,000 lbs or less.
Federal and State laws require that the Seller/Lessee disclose the mileage to the Buyer/Lessor in connection with the
transfer of ownership. An inaccurate statement, or failure to complete the statement, may result in fines and/or imprisonment,
pursuant to Section 409(a) of the Federal Motor Vehicle Information and Cost Savings Act of Public Law 92-513, and
pursuant of Vermont's Consumer Fraud Law.
Section 1 - Vehicle Information
Year
Make
Model
Vehicle Identification Number (VIN)
Body type
Section 2 - Odometer Disclosure
Federal and State law require that you furnish to the buyer a written odometer disclosure statement upon transfer of
ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment.
I certify that the odometer reading: (check one)
Reflects the actual mileage.
Enter odometer reading (no tenths)
Reflects the mileage in excess of the odometer’s mechanical limits. (A)
Is not the actual mileage. Warning - Odometer Discrepancy (B)
Section 3 – Seller/Transferor Information
Sellers name (print last, first, middle initial, or business name)
Seller’s address
City
State
Zip code
Sellers signature
X
Date of statement
Section 4 - Buyer Information
Buyer’s name (print last, first, middle initial, or business name)
Buyer’s address
City
State
Zip code
Buyers signature
X
Date of statement
Statements and warrants made herein are certified under penalty of 23 V.S.A. Sections 202,
203, 2082 & 3829 (4). If vehicle is jointly owned, only one (1) seller signature is required.
Vermont Motor Vehicle Bill of Sale Form
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