Fillable Printable Form IRP-5 - Schedule B Mileage Information (2013) - New York

Form IRP-5 - Schedule B Mileage Information (2013) - New York

New York State Department of Motor Vehicles

INTERNATIONAL REGISTRATION PLAN

SCHEDULE B MILEAGE INFORMATION

31. REG YEAR: __________ 32. ACCOUNT #: __________________ 33. FLEET #: _________ 34. CARRIER: ______________________________

38. ESTIMATED MILEAGE: ________________ 39. ACTUAL MILEAGE: ________________ 40. TOTAL OF ALL MILEAGE: ________________

41. NOTE: For any Estimated Mileage shown above, you must explain why you are using estimated mileage. This explanation needs to include information

such as business purposes, contracts, number of anticipated trips and route information (a separate sheet of paper may be used if necessary).

CERTIFICATION: I, the Undersigned, certify under penalty of perjury that the information provided in this Mileage Schedule is true and accurate to the best of my

knowledge and that the actual distance travelled, as reported on this form, is supported by the distance records maintained. I understand and acknowledge my

duty to: (a) maintain such records in compliance with IRP recordkeeping requirements for a period of six (6) years from the date of completion of each trip; (b)

promptly make such records available for audit, at any time deemed appropriate by DMV; (c) reimburse DMV for auditor travel expenses incurred should audit

require travel outside New York State; and (d) submit to monetary assessments and/or non-monetary sanctions of suspension or cancellation of my IRP account

as DMV deems appropriate.

If this Mileage Schedule is signed in my official capacity on behalf of the Carrier, I further certify that I am duly authorized to make this Certification on behalf of

such entity.

PRORATE?

Yes/No

STATE ESTIMATED

MILEAGE

ACTUAL

MILEAGE

AK (Alaska)

MI (Michigan)

VA (Virginia)

VT (Vermont)

WA (Washington)

WI (Wisconsin)

WV (West Virginia)

WY (Wyoming)

CANADA

AB (Alberta)

BC (British Columbia)

MB (Manitoba)

NB (New Brunswick)

NL (Newfoundland/

Labrador)

NS (Nova Scotia)

NT (Northwest Terr.)

ON (Ontario)

PE (Prince Edward Isl.)

QC (Quebec)

SK (Saskatchewan)

YT (Yukon)

MX (Mexico)

MN (Minnesota)

MO (Missouri)

MS (Mississippi)

MT (Montana)

NC (North Carolina)

ND (North Dakota)

NE (Nebraska)

NH (New Hampshire)

NJ (New Jersey)

NM (New Mexico)

AL (Alabama)

AR (Arkansas)

AZ (Arizona)

CA (California)

CO (Colorado)

CT (Connecticut)

DC (Dist. of Col.)

DE (Delaware)

FL (Florida)

GA (Georgia)

IA (Iowa)

ID (Idaho)

IL (Illinois)

IN (Indiana)

KS (Kansas)

KY (Kentucky)

LA (Louisiana)

MA (Massachusetts)

MD (Maryland)

ME (Maine)

IRP-5 (4/13)

AGE 1 0F 2

DMV USE ONLY

SUPP#: ________________

PRORATE?

Yes/No

STATE ESTIMATED

MILEAGE

ACTUAL

MILEAGE

NV (Nevada)

NY (New York)

OH (Ohio)

OK (Oklahoma)

OR (Oregon)

PA (Pennsylvania)

RI (Rhode Island)

SC (South Carolina)

SD (South Dakota)

TN (Tennessee)

TX (Texas)

UT (Utah)

(35) (36) (37)

REGISTRANT/

Title:

Name of Registrant/Carrier (please print):

Sign here:

Date (mm/dd/yyyy): / /

If signing as agent for a business entity, write your title (CEO, President, Vice-President, Secretary, Treasurer or

Comptroller). Anyone else signing as agent for a business entity must send in an original Power of Attorney.

reset/clear

NEW YORK STATE ESTIMATED MILEAGE CHART

AL Alabama 502

AR Arkansas 456

AZ Arizona 583

CA California 865

CO Colorado 288

CT Connecticut 1,214

DC District of Columbia 59

DE Delaware 197

FL Florida 1,204

GA Georgia 824

IA Iowa 487

ID Idaho 188

IL Illinois 734

IN Indiana 1,068

KS Kansas 260

KY Kentucky 553

LA Louisiana 298

MA Massachusetts 2,140

MD Maryland 762

ME Maine 412

MI Michigan 777

MN Minnesota 448

MO Missouri 671

MS Mississippi 304

MT Montana 131

NC North Carolina 1,151

ND North Dakota 85

NE Nebraska 390

NH New Hampshire 256

NJ New Jersey 3,539

NM New Mexico 488

NV Nevada 299

NY New York 20,969

OH Ohio 2,662

OK Oklahoma 638

OR Oregon 218

PA Pennsylvania 4,184

RI Rhode Island 177

SC South Carolina 904

SD South Dakota 51

TN Tennessee 766

TX Texas 1,263

UT Utah 413

VA Virginia 1,481

VT Vermont 679

WA Washington 350

WI Wisconsin 298

WV West Virginia 438

WY Wyoming 448

CANADA

AB Alberta 14

BC British Columbia 25

MB Manitoba 5

NB New Brunswick 11

NL Newfoundland/Labrador 1

NS Nova Scotia 1

ON Ontario 1,561

PE Prince Edward Island 27

QC Quebec 538

SK Saskatchewan 19

Miles

Per

Jurisdiction Year

Miles

Per

Jurisdiction Year

Miles

Per

Jurisdiction Year

All first-time applicants must use this mileage guide if they have no other basis for estimating their mileage. If you are providing your own

estimates, you must explain in detail how those estimates were derived. Your explanation needs to include information such as business

purposes, contracts, number of anticipated trips and route information. Please note: The miles on this guide are for one vehicle. If multiple

vehicles are being registered, adjust the mileage accordingly.

This guide may also be used to add a jurisdiction to an account or when no actual mileage has been accrued in a jurisdiction for the previous

registration year when renewing your account.

First year estimates are calculated with 100%. Second and

subsequent year estimates are calculated greater than 100%.

UNITED STATES

AND CANADA

MAP

(To assist in

calculating

continuous

mileage.)

MARYLAND

DELAWARE

NEW

JERSEY

MASSACHUSETTS

RHODE

ISLAND

VERMONT

NEW

HAMPSHIRE

NEW

BRUNSWICK

PRINCE EDWARD

ISLAND

NOVA SCOTIA

MAINE

CONNECTICUT

PAGE 2 0F 2

IRP-5 (4/13)

WASHINGTON

IDAHO

NEVADA

ARIZONA

NEW

MEXICO

TEXAS

UTAH

COLORADO

OKLAHOMA

KANSAS

NEBRASKA

WYOMING

OREGON

MONTANA

NORTH

DAKOTA

SOUTH

DAKOTA

IOWA

OHIO

KENTUCKY

VIRGINIA

CAROLINA

NORTH

NEW

YORK

TENNESSEE

GEORGIA

BRITISH

COLUMBIA

ALBERTA MANITOBA

ONTARIO

QUEBEC

NEWFOUNDLAND and LABRADOR

MICHIGAN