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State by State Mileage Record

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					INDIVIDUAL VEHICLE DISTANCE RECORD (I.V.D.R.)
IRP-26 REV. 7-2008                                                       STATE OF CONNECTICUT
                                                            DEPARTMENT OF MOTOR VEHICLES
                                                                              IRP SECTION
                                                                         On The Web At ct.gov/dmv

NAME OF REGISTRANT                                                                                               UNIT NUMBER             FLEET NUMBER



BEGINNING LOCATION OF TRIP (Origin)                (City or Town)                                  (State or Province)                   BEGINNING DATE OF TRIP



ENDING LOCATION OF TRIP (Destination)              (City or Town)                                  (State or Province)                   ENDING DATE OF TRIP




                                                                       BEGINNING ODOMETER/                           ENDING ODOMETER/                     MILES
 JURISDICTION                   TRAVEL ROUTE(S)
  (State/Province)                    (By Jurisdiction)               HUBODOMETER READING                          HUBODOMETER READING                       (By
                                                                               (By Jurisdiction)                          (By Jurisdiction)             Jurisdiction)




                                                                    TOTAL TRIP INFORMATION
BEGINNING OF TRIP ODOMETER/HUBODOMETER READING                       ENDING OF TRIP ODOMETER/HUBODOMETER READING                         TOTAL TRIP MILEAGE




NAME OF DRIVER (Please Print)                                        SIGNATURE OF DRIVER                                                 DATE SIGNED



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posted:8/19/2011
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Description: State by State Mileage Record document sample