The separate mileage certification, for the transfers where the certificate cannot carry it. A Kansas assignment normally holds the odometer entry itself, so this single sheet exists for the edges: an original disclosure travelling with a title that lacks one, a correction to a disclosure already made, and the odometer statement for a transfer of vehicle without title - the affidavit and court-document transfers where there is no assignment to write on. Its instructions are two lines long: attach original to title, the seller and buyer will each get a copy.
Written against TR-59 (Rev 12/15), issued under 49 CFR Part 580 and K.S.A. 8-135(c)(2).
The middle box row is where this form bites. The printed certification says the reading reflects actual mileage unless a statement is checked, so ticking in excess of its mechanical limits or not the actual mileage is a positive declaration, made under the federal warning of fines and imprisonment, that follows the vehicle onto its next title. Decide which sentence is true before the pen comes out, not after.
Two documents, and they are not the same thing. Take the blank TR-59 from the ksrevenue.gov copy so you get the revision that is current today, then print our TR-59 guide and keep it beside you while you fill theirs in.
This is the actual TR-59, rendered from the PDF the Kansas Department of Revenue, Division of Vehicles 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 as an original disclosure travelling with the title. Amber is the seller's certification - the statement box, the printed name in the certification sentence, the reading, the mileage box and the address lines. The signature, date and hand printed name rules stay empty on the sample: the Division's PDF puts no fillable box behind them, because they are meant for a pen at the handover.
Field by field
Every line, in the order you meet it
1
You fill this in
Title number and state
The number of the certificate this statement will be attached to, and the issuing state.
Watch out: Copy the number from the face of the title, not from a registration receipt - this sheet is only meaningful stapled to the certificate it names.
2
You fill this in
Which kind of statement
Original, correction, or the statement for a transfer of vehicle without title - the legal affidavit and court document cases.
Watch out: The third box is the one estates use: an affidavit transfer has no assignment block to carry the mileage, so this sheet stands in for it.
3
You fill this in
The reading
Your printed name in the certification sentence, then the miles now showing.
Watch out: Whole miles off the odometer on the day of transfer. A number copied from a service invoice or an insurance quote is a false statement the moment the real dash disagrees.
4
You fill this in
One of three boxes
Actual mileage, in excess of its mechanical limits, or not the actual mileage.
Watch out: A five-digit odometer that has been past 99,999 takes the mechanical-limits box with the digits actually showing. The not-actual box brands the record with the printed words odometer discrepancy - permanently.
5
You fill this in
The vehicle
Year, make, model, body style and the vehicle identification number.
Watch out: The VIN line runs the full width of the sheet for a reason - all seventeen characters, checked against the certificate.
6
You fill this in
Transferor's block
Signature, date, hand printed name and address.
Watch out: Kansas asks for the hand printed name as well as the signature - a signature alone is half the block, and the county cannot key a flourish.
7
The buyer fills this in
Transferee's block, then copies
The buyer signs, dates, prints and gives an address; then the original is attached to the title and each side keeps a copy.
Watch out: The buyer's signature is their acknowledgement of your reading. Hand the original over attached to the certificate and keep your copy with the sale papers - it is your proof of what the dash said the day the car left.
At a glance
What goes where
On the form
What to put in it
Title Number and State Title Issued
The certificate this statement will be attached to, and the state that issued it.
Check the Appropriate Box
Three kinds of statement: original odometer disclosure statement for vehicle, correction to odometer disclosure statement, and odometer statement for transfer of vehicle without title (legal affidavit or court document).
The certification
The printed sentence carrying the federal warning: failure to complete or providing a false statement may result in fines and/or imprisonment - then I, transferor's printed name, certify that the odometer now reads a stated number of miles.
The three mileage boxes
Actual mileage; in excess of its mechanical limits; not the actual mileage, printed with its own warning - odometer discrepancy.
Vehicle Information
Year, make, model and body style on one row, with the vehicle identification number on its own full-width line beneath.
Transferor's block
Signature and date, hand printed name, and address - the seller's half of the certification.
Transferee's block
The same four entries for the buyer, whose signature is the acknowledgement of the reading above.
What gets this one rejected
•Using it where the assignment can carry the disclosure. Kansas law puts the mileage inside the title assignment and makes the seller certify it there; this sheet is for the transfers that have no assignment to write on, not a substitute for one.
•A reading with tenths. The certification asks what the odometer now reads in miles - the county keys whole miles, and the decimal from the dash face is not part of the reading.
•Ticking no mileage box at all. The certification is incomplete until the reading is characterised as actual, in excess of mechanical limits, or not actual - and the federal sentence at the top attaches fines and imprisonment to leaving it false or unfinished.
•One signature. The transferor certifies and the transferee acknowledges; both blocks carry a signature and date line, and the instruction gives each side a copy because each side has signed something.
•Detaching it. The first instruction is attach original to title - a loose odometer statement proves nothing about the certificate it was meant to travel with.
Rules that decide whether it is accepted
•The exemptions live on the power-of-attorney forms. The Division prints the age test on TR-41: vehicles 2010 model year or older are exempt at 10 years, vehicles 2011 model year and newer are exempt at 20 years. An exempt transfer needs no disclosure here or anywhere.
•The not-actual box is permanent. Its printed warning - odometer discrepancy - is the brand the record carries afterwards. Tick it only when the reading genuinely cannot be vouched for, and never as caution against an odometer you merely have not checked.
•Correction has its own box. A disclosure already made wrong is fixed by a second TR-59 with correction to odometer disclosure statement ticked, not by amending the first - the Division's forms void themselves on alterations and erasures.
Every line here was read off TR-59 (Rev 12/15) itself — the PDF is here — and off the Kansas Department of Revenue, Division of Vehicles pages.
This is plain-language help with a form, not legal advice, and where our wording and the agency's differ,
theirs governs.
