Individual Vehicle Distance And Fuel Report
Download a blank fillable Individual Vehicle Distance And Fuel Report in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Individual Vehicle Distance And Fuel Report with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Instructions for completing pdf on line
Clear Form
INDIVIDUAL VEHICLE DISTANCE AND FUEL REPORT
(Must be kept by driver for each trip)
License Year _________
1.
The Individual Vehicle Distance Record and Fuel Report must account for all distance traveled and all fuel received.
2.
If you use a substitute vehicle, prepare a separate Individual Vehicle Distance and Fuel Report to account for the distance traveled and fuel received by the substitute vehicle.
Account Number
Registrant Name (Printed)
Address
Driver’s Name (Printed)
Driver’s Signature
____________________________ ______________________________
_________________________ _____________________________
Fleet Number
Vehicle Identification Number (VIN)
Trip Origin
Destination
______________________
______
______________________
______
City:
Jurisdiction:
City:
Jurisdiction:
Trip Number
Unit Number
Manifest Number
Start Date
End Date
Fuel Type
Rate Per Trip
_____ _____ _____
_____ _____ _____
Distance Per Gallon
Mo.
Day
Yr.
Mo.
Day
Yr.
Diesel ______ Gasoline ______ Other ______
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Line
Jurisdiction
Date
Highway or
Show Odometer Reading:
Jurisdiction
Name and Address (City &State)
Fuel
Fuel Invoice
Mo./Day/Yr.
Route
a.
At beginning of Trip
Distance
of Fuel Stop
Purchased
Number
Traveled
b.
When Exiting Jurisdiction
Traveled
Gallons/Liters
c.
At End of Trip
1
2
3
4
5
6
7
8
End Odometer ___________
Total Trip
Total Fuel
Distance
0
Beginning
0
__________
Odometer ______________
0
TOTAL Distance ___________
This form must be kept by the driver. Each item must be completed. Enter name of jurisdiction in which trip begins on Line 1, Column 2. Enter odometer reading at beginning of trip on Line 1, Column 5. Record name of next
jurisdiction entered and odometer reading on Line 2, Column 2 and 5, etc. Record distance traveled in each jurisdiction in Column 6. The difference between the “end odometer” reading in Column 5 should agree with total trip
distance recorded in Column 6. If hubodometer distance is used enter in Column 5, and indicate with “’HUB”.
THIS FORM MAY BE REPRODUCED
MDOS-IRP-6 (04/01/07)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Miscellaneous