Free INDIVIDUAL VEHICLE DISTANCE AND FUEL REPORT - Michigan


File Size: 313.3 kB
Pages: 1
File Format: PDF
State: Michigan
Category: Secretary of State
Author: MI Dept of State
Word Count: 283 Words, 2,136 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.michigan.gov/documents/IRPFuel-DistanceReport_75162_7.pdf

Download INDIVIDUAL VEHICLE DISTANCE AND FUEL REPORT ( 313.3 kB)


Preview INDIVIDUAL VEHICLE DISTANCE AND FUEL REPORT
Instructions for completing pdf on line
1.

INDIVIDUAL VEHICLE DISTANCE AND FUEL REPORT

Clear Form

(Must be kept by driver for each trip)

License Year _________

The Individual Vehicle Distance Record and Fuel Report must account for all distance traveled and all fuel received. 2. If you use a substitute vehicle, prepare a separate Individual Vehicle Distance and Fuel Report to account for the distance traveled and fuel received by the substitute vehicle. Driver's Name (Printed) Driver's Signature Account Number Registrant Name (Printed) Address

_________________________ _____________________________
Fleet Number Vehicle Identification Number (VIN) Trip Origin

____________________________ ______________________________
Destination

Trip Number

Unit Number

Manifest Number

City: ______________________Jurisdiction: ______ City: ______________________Jurisdiction: ______ Start Date End Date Fuel Type Rate Per Trip _____ _____ _____ _____ _____ _____ Distance Per Gallon Mo. Day Yr. Mo. Day Yr. Diesel ______ Gasoline ______ Other ______ (5) Show Odometer Reading: a. At beginning of Trip b. When Exiting Jurisdiction c. At End of Trip (6) Jurisdiction Distance Traveled (7) Name and Address (City &State) of Fuel Stop (8) Fuel Purchased Gallons/Liters (9) Fuel Invoice Number

(1) Line

(2) Jurisdiction

(3) Date Mo./Day/Yr.

(4) Highway or Route Traveled

1 2 3 4 5 6 7 8
End Odometer ___________ Beginning Odometer ______________ TOTAL Distance ___________
Total Trip Distance

Total Fuel

0 __________ 0

0

This form must be kept by the driver. Each item must be completed. Enter name of jurisdiction in which trip begins on Line 1, Column 2. Enter odometer reading at beginning of trip on Line 1, Column 5. Record name of next jurisdiction entered and odometer reading on Line 2, Column 2 and 5, etc. Record distance traveled in each jurisdiction in Column 6. The difference between the "end odometer" reading in Column 5 should agree with total trip distance recorded in Column 6. If hubodometer distance is used enter in Column 5, and indicate with "'HUB".

THIS FORM MAY BE REPRODUCED

MDOS-IRP-6 (04/01/07)