Get MI MDOS-IRP-6 2007

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. Instructions for completing pdf on line INDIVIDUAL VEHICLE DISTANCE AND FUEL REPORT Must be kept by driver for each trip License Year The Individual Vehicle Distance Record and Fuel Report must account for all distance traveled and all fuel received. 2. Driver s Name Printed Driver s Signature Account Number Registrant Name Printed Address Fleet Number Vehicle Identification Number VIN Trip Number Unit Number Manifest Number Destination Trip Origin City Jurisdiction Rate Per Trip Fuel Type End Date Start Date Distance Per Gallon Diesel Gasoline Other Mo. Day Yr. Mo. Day Date Mo. /Day/Yr. Highway or Route Traveled Jurisdiction Distance Total Trip Beginning Odometer Show Odometer Reading a* At beginning of Trip b. When Exiting Jurisdiction c* At End of Trip End Odometer Line Name and Address City State of Fuel Stop Fuel Purchased Gallons/Liters Fuel Invoice Number Total Fuel 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 distance recorded in Column 6. If hubodometer distance is used enter in Column 5 and indicate with HUB. Driver s Name Printed Driver s Signature Account Number Registrant Name Printed Address Fleet Number Vehicle Identification Number VIN Trip Number Unit Number Manifest Number Destination Trip Origin City Jurisdiction Rate Per Trip Fuel Type End Date Start Date Distance Per Gallon Diesel Gasoline Other Mo. Day Yr. Mo. Day Date Mo. /Day/Yr. Highway or Route Traveled Jurisdiction Distance Total Trip Beginning Odometer Show Odometer Reading a* At beginning of Trip b. Day Yr. Mo. Day Date Mo. /Day/Yr. Highway or Route Traveled Jurisdiction Distance Total Trip Beginning Odometer Show Odometer Reading a* At beginning of Trip b. When Exiting Jurisdiction c* At End of Trip End Odometer Line Name and Address City State of Fuel Stop Fuel Purchased Gallons/Liters Fuel Invoice Number Total Fuel TOTAL Distance This form must be kept by the driver. When Exiting Jurisdiction c* At End of Trip End Odometer Line Name and Address City State of Fuel Stop Fuel Purchased Gallons/Liters Fuel Invoice Number Total Fuel 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. 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 distance recorded in Column 6. If hubodometer distance is used enter in Column 5 and indicate with HUB. Driver s Name Printed Driver s Signature Account Number Registrant Name Printed Address Fleet Number Vehicle Identification Number VIN Trip Number Unit Number Manifest Number Destination Trip Origin City Jurisdiction Rate Per Trip Fuel Type End Date Start Date Distance Per Gallon Diesel Gasoline Other Mo. Day Yr. Mo. Day Date Mo. /Day/Yr. Highway or Route Traveled Jurisdiction Distance Total Trip Beginning Odometer Show Odometer Reading a* At beginning of Trip b. When Exiting Jurisdiction c* At End of Trip End Odometer Line Name and Address City State of Fuel Stop Fuel Purchased Gallons/Liters Fuel Invoice Number Total Fuel TOTAL Distance This form must be kept by the driver. .