The mileage lifted off the certificate and put on a sheet of its own, for the times the certificate's own block will not serve - a reading already written and corrected, a title with the transfer section used up, an out-of-state document that words the certification differently. Kentucky asks for something no neighbouring state asks for on this document: Section 3 is a certification block, and the seller's statement here is sworn in front of an attesting official.
Written against TC 96-5 (Rev 05/2020), issued under 49 U.S.C. 32705 and KRS 190.300.
Nothing on this sheet lets you declare a vehicle exempt. There are two exception boxes and no exempt box, exactly as on the certificate itself - so a car old enough to be out of federal disclosure simply does not need this form at all.
Two documents, and they are not the same thing. Take the blank TC 96-5 from the transportation.ky.gov copy so you get the revision that is current today.
This is the actual TC 96-5, rendered from the PDF the Kentucky Transportation Cabinet, Division of Motor Vehicle Licensing 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
Both exception boxes left alone, which is the certification rather than an omission - the printed sentence above them says the reading is the actual mileage unless one of them is checked. Section 3 is the half that surprises people: Kentucky swears this statement.
Field by field
Every line, in the order you meet it
1
You fill this in
Section 1, the vehicle
Year, make, model, vehicle identification number and body type, copied from the certificate.
Watch out: Body type here is the description the certificate uses, not the one the manufacturer's brochure used. Wagon, sedan, pickup - match the document.
2
You fill this in
Section 2, your name printed
Print your name and phone number and give your address, then print the name again into the opening rule of the certification sentence.
Watch out: Print in Section 2 and sign only on the signature line. The two are asked for separately for a reason.
3
You fill this in
The odometer now reads
The current reading in whole miles, into the rule marked no tenths.
Watch out: Take it off the dash on the day of the handover. The number here and the number in the assignment on the title have to be the same number.
4
You fill this in
Sign and date
Your signature and the date, on the line above Section 3.
Watch out: The date should match the date of transfer you wrote on the certificate. A different date on two documents about one sale is a question waiting to be asked.
5
You fill this in
Section 3, the attesting official
Subscribed and attested before me, then the official's signature and title, commission number and expiry.
Watch out: This is the part that makes Kentucky's version different. A county clerk's counter staff will do it while you wait, and it costs the price of a notarisation.
6
The buyer fills this in
Section 4, the buyer's half
Their name, phone, address, signature and date, acknowledging the reading you have just certified.
Watch out: Hand them the pen at the kerb and photograph the finished sheet before it leaves your hands. Federal law entitles them to a copy of it.
At a glance
What goes where
On the form
What to put in it
Instructions
Two lines at the top: attach this form to your title and registration application documents and forward to your county clerk, with the Cabinet's own county clerk directory address printed under it.
Section 1, vehicle information
Year, make and model on the first line; vehicle identification number and body type on the second.
Section 2, transferor/seller information
A printed name with a phone number beside it, then an address block.
The certification sentence
A running line - I, [name], state that the odometer now reads [reading] miles - with the seller's name under the first rule and the words no tenths under the second.
The two exception statements
Boxes for mileage in excess of its mechanical limits, and for the reading being NOT the actual mileage, the second carrying the printed warning ODOMETER DISCREPANCY.
Signature and date
The seller signs and dates on the same line.
Section 3, certification
Subscribed and attested before me on this day, a notary or attesting official signature and title, a commission number and a commission expiry broken into month, day and year.
Section 4, transferee/buyer information
Name, phone, address, then the buyer's own signature and date.
What gets this one rejected
•A reading with a decimal in it. The rule under the figure says no tenths, and a fraction is not something a clerk can key.
•Both exception statements ticked. They are alternatives - a reading has either run past the odometer's mechanical limits or is not the actual mileage.
•A figure that disagrees with the one on the back of the certificate. Two documents about one handover carrying two numbers is exactly the discrepancy this form exists to expose.
•Section 3 left blank. Kentucky wants this statement sworn, and an unsworn one is a piece of paper rather than a disclosure.
•The buyer's half missing. Federal law makes the acknowledgement the buyer's, and Section 4 has its own signature line for it.
•Filing it for a vehicle that has nothing to disclose. A pre-2011 model year old enough to be exempt does not need one, and volunteering it invites a question.
Rules that decide whether it is accepted
•It travels with the title, it does not replace it. The instruction line says attach - the certificate still has to be assigned and the assignment still has to be notarised.
•The seller certifies, the buyer acknowledges. Two signatures, two dates, and only the seller's is sworn. That asymmetry is the federal scheme showing through Kentucky's form.
