A one-page mileage statement for the times the back of the title cannot carry one. Iowa puts the odometer disclosure inside the assignment block on the certificate, so this form exists for older title stock with no mileage box, for out-of-state paper that does not have one, and for a dealer transaction that needs the disclosure on its own sheet. Both parties sign it, both print their names, and both give an address.
Written against 411077 (10-24), issued under Iowa Code s. 321.71, 761 Iowa Admin. Code 400.40, and 49 CFR pt. 580.
Iowa's ordinary route is the block on the back of the title, and using this form as well as that block creates two disclosures for one sale. Complete one or the other. If the title has a mileage box, that is the one the county treasurer will read.
Two documents, and they are not the same thing. Take the blank 411077 from the iowadot.forms.govos.com copy so you get the revision that is current today.
This is the actual 411077, rendered from the PDF the Iowa Department of Transportation, Motor Vehicle Division 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
Rendered from the department's own published form and completed as an ordinary private sale would complete it, with neither exception ticked because the reading is the true mileage. Every name, address and identification number is invented for the sample.
Field by field
Every line, in the order you meet it
1
You fill this in
Transferor's Name
Printed inside the sentence, before the mileage. The sentence is the certification, so read to the end of it first.
Watch out: Print the name that is on the front of the title. This statement and the assignment on the certificate have to be made by the same person.
2
You fill this in
The reading, no tenths
Whole miles as the dial reads on the day of the transfer.
Watch out: Read it on the day you hand the car over, not on the day you listed it. A month of driving between the two is a discrepancy you created yourself.
3
You fill this in
Statement (1), in excess of mechanical limits
A tick, only if the odometer has rolled past the highest number it can display and started again.
Watch out: A five-digit dial that has gone round is the classic case, and Iowa has a whole separate form for it - Form 411097 - when the previous title recorded six digits.
4
You fill this in
Statement (2), odometer discrepancy
A tick, only if the reading is not the actual mileage - a replaced cluster, a dead odometer, a car that was driven with it disconnected.
Watch out: This mark follows the vehicle for the rest of its life on the Iowa record. It is also the honest answer where the answer is yes, and hiding it is a fraudulent practice.
5
You fill this in
The vehicle boxes
Make, model, body type, year and the vehicle identification number.
Watch out: This form asks for body type, which the assignment block on the title does not. Take it from the front of the certificate rather than describing the car in your own words.
6
You fill this in
Your signature, printed name and address
Three separate entries, plus the date of statement.
Watch out: The address matters more than it looks. It is what a buyer's agent would use to find you if a mileage question came up later, and it is what Form 411099 asks for when they cannot.
7
The buyer fills this in
The buyer signs and prints their name
Signature, printed name, name and address, on the lower half.
Watch out: Federal law requires the transferee's acknowledgement. If the buyer is not standing in front of you, the disclosure is not finished, whatever else has been signed.
At a glance
What goes where
On the form
What to put in it
Transferor's Name (print)
Your name, inside the sentence that begins the certification, before the reading is given.
Odometer reading, no tenths
Whole miles. The form prints (no tenths) under the box so there is no argument about the trip meter.
Statement (1): in excess of mechanical limits
A tick box, for a dial that has rolled past what it can count.
Statement (2): WARNING - ODOMETER DISCREPANCY
The second tick box, certifying that the reading is not the actual mileage.
Make, Model, Body Type, Year, Vehicle Identification Number
Five boxes describing the vehicle, more detail than most Iowa forms ask for.
Transferor's or Seller's Signature and Printed Name
Two lines, one for each. Iowa asks for the print as well as the signature.
Transferor's Address
Street, city, state and zip, on their own labelled lines.
Date of Statement
The date of the disclosure, which should be the date of the transfer.
Transferee's / Buyer's Signature, Printed Name, Name and Address
The buyer's half. Four lines, and the disclosure is not complete without them.
What gets this one rejected
•Using it on a vehicle of model year 2010 or older, sold in 2026. Those are exempt under 49 CFR 580.17 as adopted in 761 IAC 400.40(3), and a disclosure that was not required is a statement you did not have to make.
•Using it on anything registered at a gross weight above 16,000 pounds. The exemption is printed on Form 411099 and applies here too.
•Ticking the discrepancy box because the mileage looks high. Not actual means the reading does not reflect the miles driven; in excess of mechanical limits means the dial has rolled over. Neither means a lot of miles.
•Signing it without the buyer. Federal law and the form both require the transferee to sign and print their name, and an unsigned buyer's half is an incomplete disclosure.
•Reaching for it when the back of the title already has a mileage block. Iowa's instruction is that the odometer statement is normally part of the assignment area, and a separate one is only obtained when the title has none.
Rules that decide whether it is accepted
•The rule is model year 2011 and newer, until 2031. 761 IAC 400.40(3) adopts 49 CFR 580.17 as in force on 1 October 2024: through 31 December 2030 every vehicle of model year 2011 or newer needs a disclosure, and from 1 January 2031 the exempt line becomes the current year minus twenty.
•The department's own selling page still prints the old Iowa rule. Its Selling to an Iowa Dealer section asks for a statement on vehicles nine model years old or newer. That was Iowa's rule until the end of 2020 and it has been wrong since.
•An electronic signature is allowed in one narrow case. The form says so on its own face: the use of electronic signature is authorized when accompanied by a Manufacturer's Certificate of Origin or Manufacturer's Statement of Origin. That is a new vehicle, not yours.
•A false statement is a fraudulent practice. s. 321.71(12), and the form's own header warns that failure to complete or providing a false statement may result in fines and/or imprisonment.
•If the mileage cannot be certified, the title says so. Where a buyer has to swear a statement because you could not be found, 761 IAC 400.40(2) makes the resulting title record not actual mileage - permanently, on the car you sold.
