Lease Turn-In Disclosure Statement US

Lease Turn-In Disclosure Statement

This document is to clarify that Sterling Heights Dodge Chrysler Jeep Ram, Inc. has been assigned only as a drop off location for your returning lease vehicle. Your leasing company will perform the final inspection at a later date. Lessee __________________________________________________ (print your name) The lessee stated above is responsible for all liabilities associated with the return of the vehicle including but not limited to, remaining payments, over-mileage, vehicle damage, missing keys, etc.

Salesperson ______________________________________ (if applicable)

lease company for your turn-in ________________ New lease company ______________ (if applicable)

Turn-in VIN ______________________________________

New VIN _____________________________________ (if applicable)

Dealer payoff amount __________________________ (if applicable)

X ____________________________________________ Date: __________________ Lessee Signature X _____________________________________________ Date: __________________ Dealer Representative Signature

Sterling Heights Dodge Inc. 40111 Van Dyke Ave Sterling Heights, MI 48313

Odometer Disclosure Statement

Federal law (and State law, if applicable) requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment.

I, _________________________________________________________ (transferor's name, Print) state that the odometer now reads ______________ (no tenths) miles and to the best of my knowledge that it reflects the actual mileage of the vehicle described below, unless of the following statements is checked.

(1) I hereby certify to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits.

(2) I hereby certify the odometer reading is NOT the actual mileage.

WARNING-ODOMETER DISCREPENCY

MAKE

MODEL

BODY TYPE

VEHICLE IDENTIFICATION NUMBER

YEAR

X TRANSFEROR'S SIGNATURE

PRINTED NAME

TRANFEROR'S STREET ADDRESS

CITY

DATE OF STATEMENT X TRANSFEREE'S SIGNATURE Sterling Heights Dodge Chrysler Jeep Ram TRANSFEREE'S NAME 40111 Van Dyke Ave. TRANSFEREE'S STREET ADDRESS Sterling Heights CITY

STATE (agent)

MI STATE

ZIP CODE

48313 ZIP CODE

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