Car Seat Declaration
revised July 2011

I acknowledge that this car seat with the serial # _____________________ and being

manufactured by _______________________________________________________
has not been involved in a car accident of any kind; has not been recalled at any time or for any purpose; and that this car seat has not expired as set out under the expiration guidelines in the car seat’s warranty manual.

Signed:

________________________________

Printed Name:

________________________________

Consignor #: _____________________

Date: ___________________________