MONTHLY FLEET MILEAGE AND FUEL SUMMARY
lefttopMONTHLY FLEET MILEAGE AND FUEL SUMMARYWisconsin Department of TransportationMV2693 11/2015See Instructions on Reverse SideName (Fuel Filer/IRP Registrant) FORMTEXT ?????Report Month FORMTEXT ?????Report Year FORMTEXT ?????Fuel or IRP Account Number FORMTEXT ?????Fleet Number FORMTEXT ?????POWER UNITVEHICLE IDENTIFICATION NUMBERorUNIT NUMBERWISCONSIN( FORMTEXT ?????)( FORMTEXT ?????)TOTALMILESFUEL (GALLONS) RECEIVEDMILESFUEL (GALLONS) RECEIVEDMILESFUEL (GALLONS) RECEIVEDMILESFUEL (GALLONS) RECEIVED FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? 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FORMTEXT ?????(Use additional pages for additional jurisdictions)Page of GENERAL INFORMATIONA Monthly Fleet Mileage and Fuel Summary must account for all gallons of fuel received and all miles traveled.INSTRUCTIONSName - enter the name of the IRP registrant or fuel tax licensee.Report Month - enter the month for which the fuel was received and mileage accumulated.Report Year - enter the calendar year for which the fuel was received and mileage traveled.Fuel and/or IRP Account Number.Fleet Number of power units.Unit or VIN - enter the vehicle identification number or unit number for each power unit.Miles, Fuel Received - enter the jurisdiction name, miles traveled and gallons of fuel received for each jurisdiction.Total - enter total miles traveled and fuel received for each vehicle.Totals - enter the total miles traveled and fuel received for each jurisdiction and for all jurisdictions.MONTHLY FLEET MILEAGE AND FUEL SUMMARYMV2693Wisconsin Department of Transportation70993003143250060960002889250063055506318250071056506318250068326008731250035433002762250013716001311275003695700131762500ExampleName (Fuel Filer/IRP Registrant)1Report Month2Report Year3Fuel or IRP Account Number4Fleet Number5POWER UNITVEHICLE IDENTIFICATION NUMBERorUNIT NUMBERWISCONSIN(Illinois)(Indiana)TOTAL 8MILESFUEL (GALLONS) RECEIVEDMILESFUEL (GALLONS) RECEIVEDMILESFUEL (GALLONS) RECEIVEDMILESFUEL (GALLONS) RECEIVED67TOTALS7366062230009(Use additional pages for additional jurisdictions)Page 1of 1 ................
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