Bill of Sale and Odometer Disclos u re Statement
DEPARTMENT OF MOTOR VEHICLES
Agenc y of Tr a nsportatio n
120 State Street
Mont pe l ie r , Ve r mont 056 03-0001
If the vehicle being sold is 9 years old or newer and you are not submitting a separate Odometer Disclosure Statement,
please complete the Odometer Disclosure Statement on the back of this form.
I / We (Seller(s)
(If a company, give company name)
hereby sell, assign or transfer ownership of the vehicle/vessel described below:
Vehicle/Vessel Identification Number
Odometer Reading (Vehicles o nl y)
IF VEHICLE IS SALVAGE , SALVAGE AND REBUILT OR TOTALED THIS SECTION MUS T BE COMPLETE D:
I/We also certify that the motor vehicle described above is:
Salvage Salvaged and Rebuilt
Declared a total loss by insurer
Any person who sells trades or offers for sale or trade any interest in a salvaged, salvaged and rebuilt or totaled vehicle shall disclose the fac
t that the vehicle has been
salvaged and rebuilt or totaled to a prospective purchaser both orally and in writing before a sale, trade or transfer is made. Written disclosure that the vehicle has been
salvaged, salvaged and rebuilt or totaled, in addition
to being disclosed on the certificate of title as required by this subchapter, shall also be conspicuously disclosed on any
b ill of sale, tr ansfer, purchase or other a g reemen t.
Failure of the seller to provide th e notices r equired by this section shall re
sult in the seller being required, at the option of the buyer, to refund to the buyer the purchase price,
includi ng t axes, license fees and similar governmental charges.
This information has been conveyed to the purchaser, both orally and in writing in accordance with 23 V.S. A. Secti ons 2093 (b ) (c), S alvaged, totaled and rebuilt vehicles.
If this section completed new owner sign:
Pur chaser ' s sign atur e:
The vehicle/vessel i s free of all li ens and encumbrances. Statements and warrants made here in are certif ie d under pen alty of
23 V.S.A. Sections 202, 203, 2082 & 3829 (4). If vehicle is joi n tly owned, bo th o wners must s ign.
Sel ler's Sig nature - if company, Au th or i zed Representati ve (include title)
Co-Seller (if jointly owned):
Buyer’s Signature - if company, Authorized Representati ve (include title)
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