Form 4012 - Historic Vehicle Log
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MISSOURI DEPARTMENT OF REVENUE
MOTOR VEHICLE BUREAU
FORM
Questions should be referred to
PO BOX 100, JEFFERSON CITY MO 65105-0100
4012
(573) 526-3669
HISTORIC VEHICLE LOG
(REV. 10-2006)
*FOR MINIMAL MILEAGE, RECORD TRIPS WEEKLY
PURPOSE FOR WHICH
DATE
MILES DRIVEN
TO/FROM
THE VEHICLE WAS DRIVEN
ACCUMULATED MILES
0
YEARLY TOTAL
MO 860-1034 (10-2006)
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Parent category: Financial