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Get Individual Vehicle Distance Record 2020-2024

Five (5) years. See page 2 for instructions to complete the form. Carrier and Vehicle Information Carrier Name Carrier Address Vehicle Unit Number Vehicle Driver Name Trip Origin State/Jurisdiction Lines Towns Trip Destination Odometer Distance by State/Jurisdiction and from Point to Point Ending Odometer City State Zip Code Fuel Type Highway or Route Traveled Date Starting and Ending Name and Address of Fuel, Load/Delivery, or Destination Stop Total Distance Per Sta.

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