This Form is used as a Bill of Sale To sell a Motor Vehicle In the State of Vermont
Vermont Motor Vehicle Bill of Sale Form
Text version of this Form
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Bill of Sale and Odometer Disclosure Statement
DEPARTMENT OF MOTOR VEHICLES 120 State Street
Agency of Transportation Montpelier, Vermont 05603-0001
802.828.2000
dmv.vermont.gov
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:
Make Model Year Body/Hull Type Vessel Length Color
Boats ft. Boats in.
Vehicle/Vessel Identification Number Odometer Reading (Vehicles only)
Miles Kilometers
Hours
To:
New Owner (Purchaser or Transferee) New Co-Owner
On: – – For: $
M M D D Y Y Y Y Purchase Price
IF VEHICLE IS SALVAGE, SALVAGE AND REBUILT OR TOTALED THIS SECTION MUST BE COMPLETED:
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 fact that the vehicle has been
salvaged, 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 bill of sale, transfer, purchase or other agreement.
Failure of the seller to provide the notices required by this section shall result in the seller being required, at the option of the buyer, to refund to the buyer the purchase price,
including taxes, 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. Sections 2093 (b) (c), Salvaged, totaled and rebuilt vehicles.
If this section completed new owner sign:
Purchaser’s signature: Date:
The vehicle/vessel is free of all liens and encumbrances. 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, both owners must sign.
Seller’s Signature – if company, Authorized Representative (include title) Date
Owner:
Co-Owner:
Seller’s Address Seller’s Phone Number
Buyer’s Signature – if company, Authorized Representative (include title) Date
Owner:
Co-Owner:
Buyer’s Address Buyer’s Phone Number
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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.
Reflects the mileage in excess of the odometer’s mechanical limits. (A)
Enter odometer reading (no tenths)
Is not the actual mileage. Warning – Odometer Discrepancy (B)
Section 3 – Seller/Transferor Information
Seller’s name (print last, first, middle initial, or business name)
Seller’s address City State Zip code
Seller’s signature Date of statement
X
Section 4 – Buyer Information
Buyer’s name (print last, first, middle initial, or business name)
Buyer’s address City State Zip code
Buyer’s signature Date of statement
X
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.
TA-VT-05 50M 07/2012 REB Vermont Telecommunications Relay Service Dial 711