Odometer / Mileage Disclosure Statement - Kia Motors Finance

[Pages:1]Odometer / Mileage Disclosure Statement

Federal law (and State law, if applicable) requires that you, the Lessee, disclose the mileage to the lessor, in connection with the transfer of ownership of the leased vehicle. Failure to complete or providing false statement may result in fines and/or imprisonment.

I, __________________ 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 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 its mechanical limits, i.e., the odometer has turned over _____ times.

I hereby certify that the odometer reading is NOT the actual mileage.

Vehicle Identification Number: Year, Make, Model, Body Type:

Lessee's Name(s): Lessee's Address: Lessee's Signature(s): Date:

DO NOT WRITE BELOW THIS LINE

Lease Account Number: Lessor's Name: Lessor's Address: Date Disclosure Form sent to Lessee: Date Completed Disclosure Form Received from Lessee: Lessor's Signature: Name & Title:

Hyundai Motor Finance P.O. BOX 20829, Fountain Valley, CA 92728-0829

Odometer Statement HMF.1.09-07-13.HCA

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