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New England 1000 Witness Form
Rider Name and Address _____________________________ _____________________________ _____________________________ _____________________________ ____________________________________________________________________________________ START Date: ________________________ Local Time:_______________________ AM/PM License Number: _______________ Odometer Reading: ________________ Miles License State: _________________ Make & Model: _____________________________
The location of this stop is: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Witness (Please Print) Witness Name: ___________________________ Title: ____________________________ Address: ___________________________ ___________________________ ___________________________ Phone: _______-___________________
Signature: ________________________________________________________ ____________________________________________________________________________________ FINISH Date: ________________________ Local Time:_______________________ AM/PM License Number: _______________ Odometer Reading: ________________ Miles License State: _________________ Make & Model: _____________________________
The location of this stop is: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Witness (Please Print) Witness Name: ___________________________ Title: ____________________________ Address: ___________________________ ___________________________ ___________________________ Phone: _______-___________________
Signature: ________________________________________________________
Witness Form Instructions While the witnesses may be a friend (but not one on the ride with you), spouse, store clerk, or gas station attendant, it is best to use a police officer, firefighter, judge, or notary public. Anyone from the authorized Iron Butt Association witness list is acceptable. The list can be found at:: http://home.earthlink.net/~s2rider/witness-state.html. If a passenger is on the ride with you, they will need a witness form also. Explain to potential witnesses that the New England 1000 may be auditing parts of your ride with a phone call or may send them a letter with a copy of the page they signed asking them to verify the information provided. Keep in mind that a witness who doesn't bother to respond to an audit letter is as good as having no witness at all!
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