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!