Free Monthly Vehicle Mileage and Fuel Summary - Wisconsin

MONTHLY VEHICLE MILEAGE AND FUEL SUMMARY
MV2688 889

Wisconsin Department of Transportation

See instructions on page 2
Power Unit Vehicle Identification Number or Unit Number Fuel or IRP Fleet No. Fuel or IRP Account Number Fuel Type Name (Fuel Filer/IRP Registrant) Report Month Report Year

D A T E 1 2 3 4 5 6 7 8 9 10 1 1 12 13 14 1 5 16 1 7 18 19 20 21 22 23 24 25 26 27 28 29 30 31

WISCONSIN
MILES FUEL (GALLONS) RECEIVED

(
MILES

)
FUEL (GALLONS) RECEIVED

(
MILES

)
FUEL (GALLONS) RECEIVED

TOTAL
ALL JURISDICTIONS MILES

ALL JURISDICTIONS FUEL (GALLONS) RECEIVED

TOTALS (Use additional pages for additional jurisdictions) Page ____ of ____

Page 1

GENERAL INFORMATION 1. 2. A Monthly Vehicle Mileage and Fuel Summary must account for all gallons of fuel purchased and all miles traveled. If you obtain a substitute vehicle, complete a separate Monthly Vehicle Mileage and Fuel Summary to account for the fuel purchased and mileage accumulated by the substitute vehicle. INSTRUCTIONS (See sample on page 3) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Vehicle Identification number (VIN) or the unit number of the power unit only. Fuel type. e.g.; (D)-Diesel, (G)-Gasoline, (P)-Propane, (GH)-Gasohol, (NG)-Natural Gas. Fuel or IRP Fleet number of the power unit only. Fuel and/or IRP Account Number. Name - Enter the legal name of the entity in whose name are the IRP registration credentials and/or fuel tax license. Report Month - Enter the month for which the fuel was purchased and mileage was accumulated. Report Year - Enter the calendar year for which the fuel was purchased and mileage accumulated. Miles, Fuel received - Enter the jurisdiction name, miles traveled and fuel received in each jurisdiction for each day of the month. The days of the month are listed at the left side of each line. Total - Enter the total miles traveled and fuel received for each jurisdiction for each day of the month. Totals - Enter the total miles traveled and fuel received for each jurisdiction for the month.

Page 2

MONTHLY VEHICLE MILEAGE AND FUEL SUMMARY
MV2688 889

Wisconsin Department of Transportation

1
Power Unit Vehicle Identification Number or Unit Number

2
Fuel Type

See instructions on page 2
Name (Fuel Filer/IRP Registrant)

99

D

March 1989
) TOTAL
ALL JURISDICTIONS

Report Month Report Year

6 7

Fuel or IRP Fleet No.

1

Fuel or IRP Account Number

3
WISCONSIN

4

WI-399587094
(

5

Harrington Heavy Hauling Inc
) (

D A T

Illinois
8

Indiana

FUEL (GALLONS)

FUEL (GALLONS)

FUEL (GALLONS)

ALL JURISDICTIONS FUEL (GALLONS)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

9

297

104

297

104

61 63 304 61

100 65

399 395 156

99

46 79

506 537 460 61

99 100 65

98 100

71 70

204 204

79

373 374

79

71

71

209

112

209

112

230

153

101

56

439

101

TOTALS

1494

10

381

1244

200

589

79

3327

660
1 1 Page ____ of ____

(Use additional pages for additional jurisdictions)

Page 3