How to fill out the Form 78-015 in Mississippi
A field-by-field walkthrough of the Mississippi Form 78-015 (Odometer Disclosure Statement) for licensed used car dealers — what goes in every section, who signs what, and the documents you attach. Verified against the official form as of October 2026.
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Filling out the MS Form 78-015 after a sale:
- What it is
- Mississippi DOR's separate odometer disclosure statement, Form 78-015-17-8-1-000
- Who completes it
- The transferor (you, on a retail sale) states the reading and signs; the transferee (the buyer) signs and prints their name
- Where to file it
- With the title paperwork it belongs to. Give the buyer a copy and keep yours for five years
- Processing time
- None. The form lists no filing step or processing time of its own
- Cost
- Free PDF from dor.ms.gov. The form has no fee line
This guide is informational and does not replace the official Mississippi instructions. Always confirm the current form and procedure with the Mississippi Department of Revenue, Motor Vehicle Services before you file.
The Form 78-015 is one car's paperwork. A 20-second read on your lot, and the tax-and-fee math for the whole deal — built for dealers, no signup. Free calculators dealers actually use — no signup, no email.
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What the Form 78-015 is and why it matters
Form 78-015 is Mississippi's Odometer Disclosure Statement: a one-page mileage statement from the Department of Revenue. The transferor states the reading, certifies it's actual unless one of two statements is marked, and both sides sign. The form prints the warning federal law requires: failing to complete it or giving a false statement may result in fines and/or imprisonment.
On most Mississippi retail deals the mileage goes on the title assignment, not on this form. Federal rules put the disclosure on the title, and on a separate document when the vehicle has never been titled. This guide walks every blank on the 78-015, shows which PDF field is which, and covers the 5-year record rule and what to do when the mileage on a title is wrong.
The full number printed on the form is 78-015-17-8-1-000, with a revision mark of "Rev(09/7)". It's a one-page PDF from the Mississippi Department of Revenue, Motor Vehicle Services. The PDF is fillable, so you can upload it to DealerVLO once under Settings → Forms. Be careful with the field names: they were generated from nearby text and most of them are wrong. The field named "MODEL" is the Make box, "YEAR" is the VIN box, and the odometer reading box is "Text28". Auto-map reads the names, so it suggests the wrong mapping on this form. Clear its suggestions and map by hand using this guide. The signature lines aren't fields; they're signed in ink.
Documents to have before you start
Gather these before you complete the Form 78-015. A missing attachment is the number-one reason the the Mississippi Department of Revenue, Motor Vehicle Services bounces a title application back.
- The title or manufacturer's certificate of origin — The form tells you to enter the transferee's name as it appears on the assignment of the MCO or title, so have it in front of you.
- The title application from MV e-Services — Its odometer reading and code should match the 78-015. See the Form 78-002 guide.
- Form 78-023, if a title already shows the wrong mileage — DOR's Affidavit for Corrected Certificate of Title – Odometer Disclosure. It's notarized and carries a $9.00 fee.
Form 78-015, section by section
When a Mississippi dealer uses Form 78-015
The form itself doesn't say when to use it, so start with the federal rule. Under 49 CFR 580.5(c), the transferor discloses the mileage on the title, or on the state's reassignment document. A seller the vehicle is titled to has to disclose on the title itself, not on a reassignment form. Under 580.5(g), a vehicle that has never been titled gets the disclosure on a separate document. That's where a stand-alone statement like the 78-015 fits. It also works as a signed record of what you disclosed, kept with the deal. It is not a reassignment form, and it is not a power of attorney. DOR publishes separate forms for those cases: Form 78-033, Authorization for Title Assignment and Mileage Disclosure, which authorizes Motor Vehicle Services to assign the title and disclose the mileage exactly as stated on it, and the Power of Attorney to Transfer Motor Vehicle.
| Field | Who fills it |
|---|---|
Titled vehicle with an open assignment Disclose on the title. 49 CFR 580.5(c). | You (dealer) |
Vehicle never titled Separate written disclosure. 49 CFR 580.5(g). | You (dealer) |
Owner authorizing DOR to assign the title Form 78-033, not the 78-015. | You (dealer) |
Title already shows the wrong mileage Form 78-023 affidavit, $9.00. | You (dealer) |
The reading and the two statements
The top line reads "I, ____ state that the odometer now reads ____ (no tenths) miles." The name blank is the transferor. On a retail sale that's the person signing for your dealership. The reading box is the PDF field "Text28". By default the statement says the reading reflects the actual mileage. There's no box for actual mileage: you only mark a blank if statement (1) or (2) applies. Statement (1) says the reading reflects mileage in excess of the odometer's mechanical limits, meaning it rolled over. Statement (2) says the reading is not the actual mileage, and carries the warning "Odometer discrepancy". In the PDF the two marking blanks are text fields, not checkboxes. In DealerVLO, map blank (1) to "odometer exceeds mechanical limits" and blank (2) to "odometer NOT actual". Each prints an X only when your deal's odometer status says so.
| Field | Who fills it |
|---|---|
I, (transferor's name) PDF field "MILES AND TO THE BEST OF MY KNOWLEDGE…". Leave unmapped and write it by hand. | You (dealer) |
Odometer now reads (no tenths) PDF field "Text28". Map to the vehicle's odometer reading. | You (dealer) |
(1) Mileage in excess of mechanical limits PDF field "1 I HEREBY CERTIFY THAT TO THE BEST…". Map to the exceeds-limits checkbox target. | You (dealer) |
(2) Not the actual mileage, warning odometer discrepancy PDF field "2 I HEREBY CERTIFY…". Map to the not-actual checkbox target. | You (dealer) |
Actual mileage No blank. Leave (1) and (2) empty. | You (dealer) |
Vehicle description
Make, model and body type sit on one line, then the VIN and year below. Copy them from the title. This is where the PDF's field names go most wrong: each name belongs to the label on the box to its right, not the box itself. Map by position, not by name.
| Field | Who fills it |
|---|---|
Make PDF field "MODEL". Map to vehicle make. | You (dealer) |
Model PDF field "BODY TYPE". Map to vehicle model. | You (dealer) |
Body type PDF field "undefined". Map to body style. | You (dealer) |
Vehicle identification number PDF field "YEAR". Map to VIN. | You (dealer) |
Year PDF field "undefined_2". Map to vehicle year. | You (dealer) |
Transferor's signature, printed name, address, and date
On a retail sale the transferor is your dealership. The transferor signs and prints their name, then gives the address and the date of the statement. Federal rules require the transferor's printed name and current address on the disclosure (49 CFR 580.5(c)). Map the four address boxes to your dealership's street, city, state and ZIP. Auto-map suggests the buyer's ZIP for the transferor's ZIP box, so change that one. The date is the sale date.
| Field | Who fills it |
|---|---|
Transferor's signature No field. Ink. | You (dealer) |
Printed name PDF field "PRINTED NAME". The person signing; leave unmapped. | You (dealer) |
Street / City or town / State / ZIP code PDF fields "STREET", "CITY OR TOWN", "STATE", "ZIP CODE". Your dealership's address. | You (dealer) |
Date of statement PDF field "DATE OF STATEMENT". Map to the sale date. | You (dealer) |
Transferee's signature, name, and address
The transferee is the buyer. They sign after reading your disclosure and print their name next to the signature. Below that, the form asks for the transferee's name exactly as it appears on the assignment of the MCO or title, then the address. Map that long name field to the buyer's full name. It's a single line, so if a co-buyer is on the title assignment too, add their name by hand. Federal rules also have the transferee sign and print their name, then give the transferor a copy (49 CFR 580.5(f)).
| Field | Who fills it |
|---|---|
Transferee's signature No field. Ink. | Buyer |
Printed name PDF field "PRINTED NAME_2". Leave unmapped; the buyer prints it. | Buyer |
Transferee's name (as on the MCO or title assignment) PDF field "TRANSFEREES NAME…". Map to buyer full name. | You (dealer) |
Street / City or town / State / ZIP code PDF fields "STREET_2", "CITY OR TOWN_2", "STATE_2", "ZIP CODE_2". The buyer's address. | You (dealer) |
Copies, exemptions, and the 5-year rule
Under 49 CFR 580.8, dealers keep a copy of every odometer disclosure statement they issue and receive for five years, at their primary place of business, filed so they can be pulled. Electronic copies count if they can't be altered. Under 580.17, a vehicle doesn't need a disclosure if it's model year 2010 or older, or model year 2011 or newer and at least 20 years old, over 16,000 pounds GVWR, or not self-propelled. In 2026 that means model year 2011 and newer get a disclosure. The roles also matter: when you take a trade or buy a car, the customer is the transferor and your dealership is the transferee. The uploaded form fills your dealership as transferor, so it fits retail sales, not purchases.
| Field | Who fills it |
|---|---|
Copy to the buyer | You (dealer) |
Your copy, kept 5 years 49 CFR 580.8. | You (dealer) |
Exempt vehicles Model year 2010 and older, 20+ model years, over 16,000 lb GVWR, not self-propelled. | You (dealer) |
Common Form 78-015 mistakes that cause rejections
The field names are wrong. Auto-map puts the mileage into the name blank and both statement blanks, the model in the Make box, the year in the VIN box, and the buyer's ZIP in your ZIP box. Clear it and map by position.
There isn't one. The statement says the reading is actual unless (1) or (2) is marked, so leave both empty.
Federal rules put the disclosure on the title when the vehicle is titled, and a titled seller must disclose on the title itself. The 78-015 doesn't replace it.
The real reading box is "Text28", the small field right after "now reads". Auto-map leaves it unmapped. Map it to the odometer reading.
Once a title shows the wrong reading, DOR's route is Form 78-023, the Affidavit for Corrected Certificate of Title – Odometer Disclosure. It's sworn before a notary and the form says a person appointed by power of attorney can't complete it.
Common questions
Where do I get a Mississippi odometer disclosure statement?+
The Mississippi Department of Revenue publishes it as Form 78-015-17-8-1-000, a free fillable PDF in its motor vehicle forms library. The download button at the top of this guide links straight to it.
Do I need Form 78-015 if the title has an odometer section?+
Not to make the disclosure. Federal rules say the transferor discloses the mileage on the title, and a seller the vehicle is titled to must disclose on the title itself. A separate statement is for a vehicle that has never been titled. You can still keep a signed 78-015 in the deal file as a record.
Is there a box for actual mileage on the Mississippi form?+
No. The statement certifies the reading is the actual mileage unless one of two statements is marked: (1) mileage in excess of the odometer's mechanical limits, or (2) not the actual mileage, with an odometer discrepancy warning. For actual mileage, mark neither.
Which vehicles are exempt from odometer disclosure?+
Under 49 CFR 580.17: model year 2010 and older vehicles; model year 2011 and newer once they're 20 years old; vehicles over 16,000 pounds GVWR; vehicles that aren't self-propelled; and a new vehicle before its first transfer for a purpose other than resale. In 2026, model year 2011 and newer need a disclosure.
How do I correct the mileage on a Mississippi title?+
DOR's Form 78-023, Affidavit for Corrected Certificate of Title – Odometer Disclosure. The purchaser gives the correct reading and the reason the title documents were wrong, signs before a notary, and pays a $9.00 fee. The form says affidavits are needed from every owner since the discrepancy happened.
How long do Mississippi dealers keep odometer statements?+
Five years. 49 CFR 580.8 requires dealers to keep a copy of every odometer disclosure they issue and receive, at their primary place of business, in a form that can be retrieved. Electronic copies are fine if they can't be altered.
Is there software that fills out the Form 78-015 automatically?+
Yes. The Mississippi Form 78-015 is a fillable PDF, so dealer management software like DealerVLO can fill it for you: upload the blank form once, DealerVLO detects its fields and suggests a mapping you confirm, and from then on it fills from every deal you enter — the buyer, co-buyer, the vehicle you sold, and your dealership's details already in place. It's $29/month flat with a 14-day free trial, and the same deal also generates your federal documents (Bill of Sale, FTC Buyers Guide, odometer disclosure) and your state title paperwork.
Stop filling out the Form 78-015 by hand.
Upload the fillable MS Form 78-015 once. DealerVLO detects its fields, you confirm the mapping, and every deal after that prints it with the buyer, co-buyer, vehicle, and your dealership already in place. $29/month. 14-day free trial, cancel any time.
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