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Get MI BDVR-108 2011

MICHIGAN DEPARTMENT OF STATE Secret ary of St at e Ruth Johnson ODOMETER MILEAGE STATEMENT www. Michigan.gov/sos See Reverse Side for Leased Vehicles 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 Make Model Body Style Vehicle Identification Number I we certify that the odometer reading is No Tenths And certify that to the best of my knowledge the odometer mileage is actual mileage Check One 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 State City Signature s of Seller s Zip Code Date X Name of Purchaser s Please Print I am aware of the above odometer certification made by the seller s. Signature s of Purchaser s BDVR-108 05/11 Authority granted under Public Act 300 of 1949 as amended* Leased Vehicles ONLY 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. Name of Lessee s Please Print Name of Lessor Please Print Date Odometer Statement Sent to Lessee Date Received From Lessee Name of Lessor s Agent Please Print Signature of Agent. Year Make Model Body Style Vehicle Identification Number I we certify that the odometer reading is No Tenths And certify that to the best of my knowledge the odometer mileage is actual mileage Check One 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 State City Signature s of Seller s Zip Code Date X Name of Purchaser s Please Print I am aware of the above odometer certification made by the seller s. Name of Seller s Please Print Address State City Signature s of Seller s Zip Code Date X Name of Purchaser s Please Print I am aware of the above odometer certification made by the seller s. Signature s of Purchaser s BDVR-108 05/11 Authority granted under Public Act 300 of 1949 as amended* Leased Vehicles ONLY 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. Signature s of Purchaser s BDVR-108 05/11 Authority granted under Public Act 300 of 1949 as amended* Leased Vehicles ONLY 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. Name of Lessee s Please Print Name of Lessor Please Print Date Odometer Statement Sent to Lessee Date Received From Lessee Name of Lessor s Agent Please Print Signature of Agent. Year Make Model Body Style Vehicle Identification Number I we certify that the odometer reading is No Tenths And certify that to the best of my knowledge the odometer mileage is actual mileage Check One 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 State City Signature s of Seller s Zip Code Date X Name of Purchaser s Please Print I am aware of the above odometer certification made by the seller s. Signature s of Purchaser s BDVR-108 05/11 Authority granted under Public Act 300 of 1949 as amended* Leased Vehicles ONLY 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. .

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