MV2687
4/2003
Record the Odometer Reading:
1. At the beginning of each day or trip. 2. When leaving each Jurisdiction. 3. At the end of each day or trip.
DAILY VEHICLE MILEAGE AND FUEL REPORT
Wisconsin Department of Transportation (IRP & IFTA Vehicles Only)
Name (Fuel Filer/IRP Registrant)
Instructions
Clear Form
See instructions on reverse side
Fuel Filer Name (If Other Than IRP Registrant) Driver(s) Name
Power Unit Vehicle Identification Number or Unit Number
Power Unit Fleet Number Fuel Type
AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY MX AB BC NB NK NF NT NS ON PE PQ SK YT
MILEAGE INFORMATION
TRIP DATE HIGHWAYS USED JURISDICTION NAME
ODOMETER READING
FUEL INFORMATION
JURISDICTION MILES GALLONS RECEIVED VENDOR NAME ORIGIN
TRIP INFORMATION
DESTINATION
BEGIN
END
TOTAL TRIP MILES
Back
GENERAL INFORMATION A Daily Vehicle Mileage and Fuel Report must account for all miles traveled and all fuel received. 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. INSTRUCTIONS 1. 2. 3. 4. 5. 6. Vehicle Identification Number or Unit Number of power unit. Fleet Number of power unit. Fuel Type: (D) diesel, (G) gasoline, (P) propane, (GH) gasohol, (NG) Natural gas. Name of the IRP registrant or fuel tax licensee. Fuel Filer - complete if different than 4. Driver(s) Name(s).
MILEAGE INFORMATION 7. Trip Date 8. Highways used - e.g.; I90, STH 69 9. Jurisdiction Name - abbreviation of the jurisdiction in which your vehicle is traveling, e.g., 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 trip. 11. Jurisdiction Miles - record the mileage traveled in each jurisdiction by trip date. 12. Total trip miles - Record total trip miles. FUEL INFORMATION 13. Gallons received. 14. Vendor name (name from whom you received fuel). TRIP INFORMATION 15. Origin - Where trip started. 16. Destination - Where trip ended.
MV2687
Record the Odometer Reading:
1
1. At the beginning of each day or trip. 2. When leaving each Jurisdiction. 3. At the end of each day or trip.
DAILY VEHICLE MILEAGE AND FUEL REPORT
2 3
Wisconsin Department of Transportation (IRP & IFTA Vehicles Only) 4
Name (Fuel Filer/IRP Registrant)
5
Fuel Filer Name (If Other Than IRP Registrant)
Example
Driver(s) Name
Power Unit Vehicle Identification Number or Unit Number
Power Unit Fleet Number Fuel Type
6
AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY MX AB BC NB NK NF NT NS ON PE PQ SK YT
MILEAGE INFORMATION
TRIP DATE HIGHWAYS USED JURISDICTION NAME
ODOMETER READING
FUEL INFORMATION
JURISDICTION MILES GALLONS RECEIVED VENDOR NAME ORIGIN
TRIP INFORMATION
DESTINATION
BEGIN
7
8
9
10
11
13
14
15
16
END
12
TOTAL TRIP MILES