Form Efo00240 - Individual Vehicle Mileage And Fuel Report - 1999 Page 2
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1
2INSTRUCTIONS
An Individual Vehicle Mileage and Fuel Report must account for all miles traveled and all fuel purchased. If you use a substitute vehicle, prepare a separate
Individual Vehicle Mileage and Fuel Report to account for the miles traveled and fuel received by the substitute vehicle.
SPECIFIC INSTRUCTIONS
(Numbers correspond to sample below)
1.
Vehicle Identification Number (VIN) or Unit
Number of power unit.
2.
Fleet Number of power unit.
3.
Fuel Type: (D) - Diesel, (G) - Gasoline,
(P) - Propane, (GH) - Gasohol, (NG) -Natural
Gas.
4.
Legal name of the IRP registrant or fuel tax
licensee.
5.
Name of fuel filer (if different from #4).
6.
Driver(s)' Name(s)
7.
Trip Origin (where trip started)
8.
Destination (where trip ended)
9.
Date(s) of trip.
10.
Highways used, e.g., I-84, Hwy 55
11.
Jurisdiction name--enter the abbreviation of the
U.S. state or Canadian province in which the
vehicle is traveling.
12.
Odometer Reading:
a. Record at the beginning of the trip (should be
ending odometer reading from previous trip),
b. Record when leaving each jurisdiction, and
c. Record at the end of the trip.
13.
Record the mileage traveled in each jurisdiction
by trip date.
14.
Record total trip miles.
15.
Vendor name and address of each fuel stop, or
each intermediate stop.
16.
Fuel invoice number.
17.
Number of gallons purchased.
18.
Total number of gallons purchased during trip.
EFO00240
06-30-99
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