Free mv2693 - Wisconsin

MONTHLY FLEET MILEAGE AND FUEL SUMMARY
MV2693 4/2003 See Instructions on reverse side
Name (Fuel Filer/IRP Registrant)

Wisconsin Department of Transportation

Instructions
Report Month

Clear Form
Report Year

Fuel or IRP Account Number

Fleet Number

POWER UNIT VEHICLE IDENTIFICATION NUMBER or UNIT NUMBER

WISCONSIN
MILES FUEL (GALLONS) RECEIVED

(
MILES

)
FUEL (GALLONS) RECEIVED

(
MILES

)
FUEL (GALLONS) RECEIVED MILES

TOTAL
FUEL (GALLONS) RECEIVED

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

Back

GENERAL INFORMATION A Monthly Fleet Mileage and Fuel Summary must account for all gallons of fuel received and all miles traveled.

INSTRUCTIONS

1. Name - enter the name of the IRP registrant or fuel tax licensee. 2. Report Month - enter the month for which the fuel was received and mileage accumulated. 3. Report Year - enter the calendar year for which the fuel was received and mileage traveled. 4. Fuel and/or IRP Account Number. 5. Fleet Number of power units. 6. Unit or VIN - enter the vehicle identification number or unit number for each power unit. 7. Miles, Fuel Received - enter the jurisdiction name, miles traveled and gallons of fuel received for each jurisdiction. 8. Total - enter total miles traveled and fuel received for each vehicle. 9. Totals - enter the total miles traveled and fuel received for each jurisdiction and for all jurisdictions.

MONTHLY FLEET MILEAGE AND FUEL SUMMARY
MV2693

Wisconsin Department of Transportation

Example
Name (Fuel Filer/IRP Registrant)

1

Report Month

2 4

Report Year

3
Fleet Number

Fuel or IRP Account Number

5 8
FUEL (GALLONS) RECEIVED

POWER UNIT VEHICLE IDENTIFICATION NUMBER or UNIT NUMBER

WISCONSIN
MILES FUEL (GALLONS) RECEIVED

(

Illinois
MILES

)

(

Indiana
MILES

)
MILES

TOTAL

FUEL (GALLONS) RECEIVED

FUEL (GALLONS) RECEIVED

6

7

TOTALS

9
(Use additional pages for additional jurisdictions) Page ____ of ____ 1 1