Appendix E "Individual Vehicle Mileage and Fuel Report" - Maine

What Is Appendix E?

This is a legal form that was released by the Maine Department of the Secretary of State - a government authority operating within Maine. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Maine Department of the Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Appendix E by clicking the link below or browse more documents and templates provided by the Maine Department of the Secretary of State.

ADVERTISEMENT
ADVERTISEMENT

Download Appendix E "Individual Vehicle Mileage and Fuel Report" - Maine

1346 times
Rate (4.5 / 5) 94 votes
INDIVIDUAL VEHILCE MILEAGE AND FUEL REPORT
(Must be kept by the driver for each trip)
License Year__________
INDIVIDUAL VEHICLE MILEAGE AND FUEL CHART
(Must be kept by driver for each trip)
1) The individual vehicle mileage record and fuel report must account for all miles traveled and all fuel received.
2) If you use a substitute vehicle, prepare a separate Individual Vehicle Mileage and Fuel Report to account for
the miles traveled and the fuel received by the substitute vehicle.
Account Number
Registrant Name (Printed)
Address
Driver’s Name (Printed)
Driver’s Signature
_____________________
___________________________
___________________________
________________________________
Fleet Number
VIN Number
Trip Origin
Destination
City:
Jur:
City
Jur:
Trip Number
Unit Number
Manifest
Start Date
End Date
Fuel Type
Rate per Trip
Number
Diesel______ Gasoline______
MPG
____ _____ ____
____ _____ ____
Other_______
Mo. Day
Yr.
Mo. Day
Yr.
Please Specify________
-1
-2
-3
-4
-5
-6
-7
-8
-9
Line
Jurisdiction
Date
Highway or
Show Odometer Reading
Jurisdictional
Name and Address
Fuel
Fuel
(Mo/Day/Yr)
Route
a. At Beginning of Trip
City & State
Purchased
Invoice
Traveled
b. When Exiting Jurisdiction
Miles
(Of Fuel Stop)
(Gallons)
Number
c. At End of Trip
Traveled
1
2
3
4
5
6
7
8
Notes:
End Odometer_____________
Total Trip
Total
Miles
Fuel
(Minus)
Beginning -
Odometer
_____________
=
Total Miles
_____________
__________
__________
This form must be kept by the driver. Each item must be completed. Enter name of the 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, Columns 2 and 5, etc.
Record miles traveled in each jurisdiction in column 5. The difference between the 'end odometer' and 'beginning odometer' reading in column 5 should agree with total
trip miles recorded in column 6. If hubodometer miles are used, enter in Column 5, and indicate with "HUB".
THIS FORM MAY BE REPORDUCED
Appendix E
INDIVIDUAL VEHILCE MILEAGE AND FUEL REPORT
(Must be kept by the driver for each trip)
License Year__________
INDIVIDUAL VEHICLE MILEAGE AND FUEL CHART
(Must be kept by driver for each trip)
1) The individual vehicle mileage record and fuel report must account for all miles traveled and all fuel received.
2) If you use a substitute vehicle, prepare a separate Individual Vehicle Mileage and Fuel Report to account for
the miles traveled and the fuel received by the substitute vehicle.
Account Number
Registrant Name (Printed)
Address
Driver’s Name (Printed)
Driver’s Signature
_____________________
___________________________
___________________________
________________________________
Fleet Number
VIN Number
Trip Origin
Destination
City:
Jur:
City
Jur:
Trip Number
Unit Number
Manifest
Start Date
End Date
Fuel Type
Rate per Trip
Number
Diesel______ Gasoline______
MPG
____ _____ ____
____ _____ ____
Other_______
Mo. Day
Yr.
Mo. Day
Yr.
Please Specify________
-1
-2
-3
-4
-5
-6
-7
-8
-9
Line
Jurisdiction
Date
Highway or
Show Odometer Reading
Jurisdictional
Name and Address
Fuel
Fuel
(Mo/Day/Yr)
Route
a. At Beginning of Trip
City & State
Purchased
Invoice
Traveled
b. When Exiting Jurisdiction
Miles
(Of Fuel Stop)
(Gallons)
Number
c. At End of Trip
Traveled
1
2
3
4
5
6
7
8
Notes:
End Odometer_____________
Total Trip
Total
Miles
Fuel
(Minus)
Beginning -
Odometer
_____________
=
Total Miles
_____________
__________
__________
This form must be kept by the driver. Each item must be completed. Enter name of the 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, Columns 2 and 5, etc.
Record miles traveled in each jurisdiction in column 5. The difference between the 'end odometer' and 'beginning odometer' reading in column 5 should agree with total
trip miles recorded in column 6. If hubodometer miles are used, enter in Column 5, and indicate with "HUB".
THIS FORM MAY BE REPORDUCED
Appendix E