The mileage statement on a sheet of its own, for when the block on the certificate cannot be used - spoiled, full, or missing from an older title. It carries the identical certification the title carries, because both are the wording Section 3-112.1 of the Vehicle Code prints in quotation marks.
Written against VSD 333 (VSD 333.4, February 2016), issued under 625 ILCS 5/3-112.1.
This does not replace the assignment on the certificate. It supplements it where the certificate's own block cannot carry the statement, and the buyer still has to have a properly assigned title in hand to apply.
Two documents, and they are not the same thing. Take the blank VSD 333 from the ilsos.gov copy so you get the revision that is current today.
This is the actual VSD 333, rendered from the PDF the Illinois Secretary of State publishes and completed end to end: letterhead, every field, and the blocks at the foot.
Amber — you write it
Grey — not yours to fill
Numbered — explained below
Filled in on the right-hand copy, because that is the only one the Secretary of State made fillable - and the left one still names the department's old web address. Both signature rules are deliberately left blank: they carry no field, and they are the two lines on this sheet that have to be signed by hand.
Field by field
Every line, in the order you meet it
1
You fill this in
Your name, in the certification sentence
The first blank sits inside the sentence rather than under a label: I, ______, certify to the best of my knowledge that the odometer reading now reads...
Watch out: Print it the way the certificate has it. This sentence is the statement; the name in it is who is making it.
2
You fill this in
The reading
Whole miles into the second blank, which is labelled no tenths on its own line.
Watch out: Read it off the dash with the ignition on, not off the last service invoice. A digital cluster that shows a trip meter by default has caught out better people than you.
3
You fill this in
The two boxes
In excess of its mechanical limits, or not the actual mileage - warning, odometer discrepancy.
Watch out: Both are admissions and neither is an exemption. If the car is old enough that no statement is required at all, the answer is not to use this form, rather than to tick something.
4
You fill this in
Year, Make, Body Type, Model
Four boxes across one row.
Watch out: Body type is not the model. Illinois wants a body description in one and the model name in the other, and putting the model in both leaves a clerk guessing.
5
You fill this in
Vehicle Identification Number
Seventeen characters into the long box under the vehicle row.
Watch out: Copy from the certificate. The disclosure only means anything against a vehicle that can be identified.
6
You fill this in
Seller's Signature - no field, on purpose
A printed rule between the VIN box and your printed name. It carries no fillable field.
Watch out: Sign it in ink. On the sample above it is left blank so you can see that the gap is real and not an oversight in our copy.
7
You fill this in
Printed name, address, certification date
Your name, a street line, a city, state and ZIP line, and the date you are certifying.
Watch out: The certification date is the date you sign, and it should not be later than the date of sale on the rest of the paperwork.
8
The buyer fills this in
The buyer's half
Signature on a rule with no field, printed name, street, city, state and ZIP, and an acknowledgment date.
Watch out: The buyer is acknowledging your statement, not making one of their own. Leave it and the sheet is an assertion nobody has received.
At a glance
What goes where
On the form
What to put in it
The certification line
I certify to the best of my knowledge that the odometer reading now reads _____ (no tenths) miles and reflects the actual mileage of the vehicle described below, unless one of the following statements is checked. Your name goes in the first blank.
The two checkboxes
The mileage stated is in excess of its mechanical limits; the odometer reading is not the actual mileage, warning odometer discrepancy. Two, not three. Neither is an exemption.
Year, Make, Body Type, Model
Four short boxes on one row. Body type is a separate answer from model here, which the certificate also asks for.
Vehicle Identification Number
One long box beneath them.
Seller's Signature
A printed rule with no fillable field behind it. Ink only.
Seller's Printed Name, Address and Certification Date
Printed name, a street line, a city, state and ZIP line, and the date you are certifying.
To be completed by the buyer
The whole lower half: buyer's signature on a rule with no field, then printed name, street, city, state and ZIP, and an acknowledgment date.
What gets this one rejected
•Using it to correct a reading already written on a title. Illinois handles a mistake in the assignment on VSD 393 - which then says in a note that it cannot itself be used for odometer disclosure or corrections. Read both sentences before choosing a form.
•Filling in only the top half. The lower half is headed to be completed by the buyer and their acknowledgment is what makes the statement a disclosure rather than an assertion.
•Tenths. The box says no tenths and the certification underneath mentions fines and imprisonment in the same sentence.
•Typing the signatures. The two signature rules are the only lines on the sheet with no fillable field behind them, which is as clear a hint as a form gives.
•Filling in the left-hand copy. The Secretary of State prints this form twice on one sheet and made only the right-hand copy fillable.
Rules that decide whether it is accepted
•The warning is federal and state at once. Printed at the head of the form: federal and state laws require that you state the mileage in a transfer of ownership, and failure to complete or providing a false statement may result in fines and/or imprisonment. That is not decoration. The state half of it, in Section 3-112.1 of the Vehicle Code, creates a private right of action for a buyer against a seller who states a reading with intent to defraud, and puts the floor at three times actual damages.
•Two copies, two web addresses. The sheet carries the form twice side by side. The left-hand copy still gives the office's address as www.cyberdriveillinois.com, the domain the Secretary of State used before ilsos.gov. The right-hand copy is current, and is the fillable one.
Every line here was read off VSD 333 (VSD 333.4, February 2016) itself —
the PDF is here — and off the Illinois Secretary of State pages.
This is plain-language help with a form, not legal advice, and where our wording and the agency's differ,
theirs governs.
