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On, I/we, Month, Day Year of Sale/Transfer Seller/(s)’/Transferor(s)’ Full Legal Name(s) Seller/(s)’/Transferor(s)’ Street Address, City, State Zip Court Order Case Number Georgia Tax ID Number Sold/transferred the following vehicle Vehicle Year /Make/Identification Number To Purchaser(s)’/Transferee(s)’ Full Legal Name(s) Purchaser(s)’/Transferee(s)’ Street Address, City, State Zip Seller(s)/Transferor(s) further states that there are no liens, security interests, or encumbrances on this vehicle except as listed below: Lien, Security Interest or Encumbrance Holder(s)’ Name(s) Lien, Security Interest or Encumbrance Holder(s)’ Street Address, City, State Zip Federal regulations require the seller(s)/transferor(s) to disclose the odometer reading and the purchaser(s)/transferee(s) to acknowledge the odometer reading upon the transfer of ownership of a vehicle that is not exempt from odometer disclosure requirements..
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