STATE OF ALASKA - DIVISION OF MOTOR VEHICLES
ODOMETER DISCLOSURE STATEMENT
License Plate Number State Serial Number (VIN)
Year Make Model Body Style Color Odometer (Miles -No Tenths)
Federal law requires that you state the mileage upon transfer of ownership. Failure to complete this or providing a false
statement may result in fines and/or imprisonment.
I, , state that the odometer reading shown above is true and correct
to the best of my knowledge and that it reflects the actual mileage of the vehicle described above unless one of the
following statements is checked.
_____ I hereby certify that to the best of my knowledge the odometer reading reflects the amount of mileage in excess
of it’s mechanical limits.
_____ I hereby certify that the odometer reading is not the actual mileage. WARNING - - ODOMETER DISCREPANCY
Sellers Signature Date Buyer’s Signature Date
Printed Name Printed Name
Street Address Street Address
City / State/Zip City/State/Zip
839 (Rev. 2/1999) www.state.ak.us/dmv/
After printing, please check the information carefully and then sign the form.
This form is only needed if you meet the following guidelines:
• The previous title does not have any place for both the buyer and seller to disclose the mileage.
• The empty weight of the vehicle is 12,000 pounds or less.
• The vehicle is less than 10 years old.*
* DMV will record the mileage, if known, for vehicles over 10 years old. It is not a requirement of
To convert kilometers to miles, use the following formula: _____ kilometers x .62 = _______ miles
If the exact reading is unknown, the reading to the nearest 1,000 miles is acceptable.
Please do not guess, as this cannot be changed once you make the statement.