Transcription of Record the Odometer Reading: DAILY VEHICLE MILEAGE AND ...
1 MV2687 4/2003 See instructions on reverse sideJURISDICTIONNAMEJURISDICTIONMILESEND TOTAL TRIP MILESHIGHWAYS USEDODOMETER READINGBEGINTRIPDATEP ower Unit VEHICLE Identification Number or Unit NumberORIGINDESTINATIONTRIP INFORMATIONFUEL INFORMATIONR ecord the Odometer Reading: 1. At the beginning of each day or When leaving each At the end of each day or ALAKAZARCACOCTDEDCFLGAIDILINIAKSKYLAMEMD MAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISC SDTNTXUTVTVAWAWVWIWYMXABBCNBNKNFNTNSONPE PQSKYTMILEAGE INFORMATIONName (Fuel Filer/IRP Registrant)Fuel TypePower Unit Fleet NumberFuel Filer Name (If Other Than IRP Registrant)Driver(s) NameDAILY VEHICLE MILEAGE AND FUEL REPORTW isconsin Department of Transportation(IRP & IFTA Vehicles Only)GENERAL INFORMATION A DAILY VEHICLE MILEAGE and Fuel Report must account for all miles traveled and all fuel received.
2 If you use a substitute VEHICLE , prepare a separate DAILY VEHICLE MILEAGE and Fuel Report to account for the miles traveled and fuel received by the substitute VEHICLE Identification Number or Unit Number of power Fleet Number of power Fuel Type: (D) diesel, (G) gasoline, (P) propane, (GH) gasohol, (NG) Natural Name of the IRP registrant or fuel tax Fuel Filer - complete if different than Driver(s) Name(s). MILEAGE INFORMATION7. Trip Date8. Highways used - ; I90, STH 699. Jurisdiction Name - abbreviation of the jurisdiction in which your VEHICLE is traveling, , WI for Wisconsin, etc. 10. Odometer Reading: a. Record at the beginning of each day or trip. b. When leaving each jurisdiction. c. At the end of each day or Jurisdiction Miles - Record the MILEAGE traveled in each jurisdiction by trip date.
3 12. Total trip miles - Record total trip miles. FUEL INFORMATION13. Gallons Vendor name (name from whom you received fuel).TRIP INFORMATION15. Origin - Where trip Destination - Where trip ended. JURISDICTIONNAMEJURISDICTIONMILESENDTOTA L TRIP MILESHIGHWAYS USEDODOMETER READINGBEGINTRIPDATEP ower Unit VEHICLE Identification Number or Unit NumberORIGINDESTINATIONTRIP INFORMATIONFUEL INFORMATIONR ecord the Odometer Reading: 1. At the beginning of each day or When leaving each At the end of each day or ALAKAZARCACOCTDEDCFLGAIDILINIAKSKYLAMEMD MAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISC SDTNTXUTVTVAWAWVWIWYMXABBCNBNKNFNTNSONPE PQSKYTMILEAGE INFORMATIONName (Fuel Filer/IRP Registrant)Fuel TypePower Unit Fleet NumberFuel Filer Name (If Other Than IRP Registrant)Driver(s) NameDAILY VEHICLE MILEAGE AND FUEL REPORTW isconsin Department of Transportation(IRP & IFTA Vehicles Only)61615141311109128712345 ExampleMV2687
