Form 1810 - South Dakota Individual Vehicle Mileage And Fuel Report Page 2
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1
2INSTRUCTIONS
GENERAL INFORMATION
1. An Individual Vehicle Mileage and Fuel Report must account for all miles traveled and all fuel received.
2. If you use a substitute vehicle, prepare a seperate Individual Vehicle Mileage and Fuel Report to account for the miles traveled and fuel received
by the substitute vehicle.
FORM INSTRUCTIONS
1. Vehicle identification number of unit number of power unit.
2. Fleet number of power unit.
3. Fuel Type:
D
R
I
V
E
R
A
N
D
U
N
T I
I
N
F
O
R
M
A
I T
O
N
(D) diesel, (G) gasoline, (P) propane, (GH) gasohol
1
2
3
4
5
P
o
w
r e
U
t i n
V
h e
c i
e l
P
o
w
r e
U
t i n
F
u
l e
y T
e p
N
a
m
e
F (
u
l e
l i F
/ r e
R I
P
R
e
s i g
a r t
/ t n
t O
e h
) r
D
v i r
r e
) s (
N
a
m
e
N
u
m
b
r e
f o
U
t i n
N
u
m
b
r e
F
e l
t e
N
u
m
b
r e
(NG) natural gas.
M
I
L
A
G
E
I
N
F
O
R
M
A
I T
O
N
F
U
E
L
I
N
F
O
R
M
A
I T
O
N
T
R
P I
I
N
F
O
R
M
A
I T
O
N
T
p i r
D
a
e t
i H
h g
w
a
s y
U
s
d e
u J
s i r
i d
i t c
n o
N
a
m
e
B
g e
n i
i n
g n
O
o d
m
e
r e t
E
n
i d
g n
O
o d
m
e
r e t
u J
s i r
i d
i t c
n o
M
i
s e l
G
a
o l l
s n
e V
d n
r o
N
a
m
e
O
g i r
n i
D
s e
n i t
i t a
n o
4. Legal name of the IRP registrant or fuel tax licensee.
R
e
e c
v i
d e
6
7
8
9a
9b
10
12
13
14
15
A
L
5. Driver(s) name(s).
A
K
A
Z
A
R
C
A
C
O
C
T
D
E
D
C
MILEAGE INFORMATION
F
L
G
A
D I
6. Trip date.
L I
N I
A I
K
S
7. Highways used - routes of travel
K
Y
L
A
M
E
8. Jurisdiction name - abbreviation of the jurisdication
M
D
M
A
M
I
M
N
in which your vechicle is traveling.
M
S
M
O
M
T
9a - 9b. Odometer reading:
N
E
N
V
N
H
J
N
Record at the beginning of each day or trip.
N
M
N
Y
N
C
When leaving or entering a jurisdiction, record your
N
D
O
H
O
R
P
A
beginning and ending odometer.
I R
S
C
S
D
T
N
10. Jurisdiction miles - record the mileage traveled in
T
X
T I
V
T
each jurisdiction trip date.
V
A
W
A
W
V
W
I
11. Total trip miles - record total trip miles
W
Y
M
X
A
B
B
C
N
B
N
K
N
F
FUEL INFORMATION
N
T
N
S
O
N
12. Gallons received.
P
E
P
Q
S
K
Y
T
13. Vendor name (name of whom you received fuel).
11
TOTAL TRIP MILES
TRIP INFORMATION
14. Origin - Where trip started
15. Destination - Where trip ended.
1.
PRINT FOR MAILING
CLEAR FORM
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