ࡱ> :=9 m bjbjR|R| 300Wtt86.RRRRR3.5.5.5.5.5.5.$0V3Y.Y.RRHn.~~~FRR3.~3.~~rG)T#*R:o$F)..0.)z3&X3#*3#*~Y.Y.~.3t : 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, 2015 through October 31, 2016 _______________ _______________ _______________ 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: Tom Randall A copy should be retained by Department's/Agency's Administrative Unit for audit purposes       BRT ʽʪ}}m[L=[h%6@OJQJ]^Jh{6@OJQJ]^J"h"7 h;26@OJQJ]^Jh;26>*@OJQJ]^JhUF6@OJQJ]^Jh}Z]6@OJQJ]^Jh;26@OJQJ]^J$h_e=h;2@CJOJQJ^JaJh_e=h;2@CJaJ*h_e=h;25@CJOJQJ\^JaJh_e=h;26@CJ]aJh_e=hi 6@CJ]aJ  #BTU$ % f g $ 0dxa$gd.} $ 0a$gd;2 $ Ha$gd;2gd;2$a$gd;2 $ 0a$gd;2$a$gd6x V W ʸlS:l*hP%h,h6@CJ]aJ0h,/5@B*CJKH\aJmH nH phu0hP%5@B*CJKH\aJmH nH phu6h_e=hc!5@B*CJKH\aJmH nH phuh;26@OJQJ]^Jh%6@OJQJ]^J"h"7 hP6@OJQJ]^J"h"7 h}Z]6@OJQJ]^J"h"7 hTX6@OJQJ]^J"h"7 h;26@OJQJ]^J"h"7 hi 6@OJQJ]^J  - .    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