ࡱ> BEA bjbj 3*rr tt84N,"/zzzzz.......$13..zzH. Fzz. . r)T*z>Jj)*..0"/7*zn4rn4*n4* .. "/n4t : REPORT A "BUSINESS PURPOSES ONLY" USE OF STATE OF MAINE VEHICLES (No Personal Use) Department______________________________________________________ Agency/Division___________________________________________________ Vehicle License Plate, Vehicle Year, Make and Model_____________________ Employee's Name_________________________________________________ Date(s) of Use____________________________________________________ Mileage November l, 2013 through October 31, 2014 _______________ _______________ _______________ Start Stop Total I understand that the vehicle is assigned for State business purposes only and has not been used for personal purposes other than de minimis use. This is to satisfy substantiation record requirements in accordance with PL 99-44. Employee's Signature________________________________ Date__________ Supervisor's Signature______________________________ Date__________ The original should be sent to the Office of the State Controller, SHS#14, Attn: April Newman. A copy should be retained by Department's/Agency's Administrative Unit for audit purposes REPORT B "BUSINESS COMMUTE PURPOSE ONLY" USE OF STATE OF MAINE VEHICLES (Commuting Use Allowed) Elected Officials or Government Employees Earning $147,200 or More in 2014 must file Report C. Department_______________________________________________________ Agency/Division____________________________________________________ Vehicle License Plate, Vehicle Year, Make and Model______________________ Employee's Name__________________________________________________ Social Security Number______________________________________________ Number of Days Vehicle is used to commute _________X $3.00 =____________ Do not report 0.00, complete Report A. Report A does not include your social security number. Mileage November 1, 2014 through October 31, 2014 ______________ _______________ ______________ Start Stop Total I understand that this vehicle is assigned for State business purposes, other than de minimis use, and commuting to and/or from work. During non-business use the vehicle is stored at ______________________________________________________ This information is to satisfy substantiation record requirements in accordance with PL 99-44. Employee's Signature_____________________________ Date__________ Supervisor's Signature___________________________ Date__________ The original should be sent to the Office of the State Controller, SHS#14, Attn: April Newman. 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