Type of Vehicle:
____________________________________________________________
Year Make & Model
To be used by all taxpayers who use a vehicle for both
business and personal use, and whenever a 5% or more owner uses a vehicle. Answers to these questions should be carried
over to the employee’s personal federal income tax return.
PART 1
Personal miles
driven during the year: ______________________________
Business
miles driven during the year: ______________________________
Total
miles driven during the year: ______________________________
Mileage
for commuting back and forth to work,
Included in
personal miles above?
______________________________
Is there
another vehicle at home available?
For personal use: Yes___________
No__________
Is there
evidence to determine business use? Yes_________ No_________
Is the
evidence written: Yes___________
No _________
The
vehicle is (owned\leased) by: ME PERSONALLY____ MY BUSINESS_____
My
business is: An Individual
Proprietorship _________
Corporation __________ % Owned_________
Partnership __________ %Owned _________
Date the
vehicle was first used for business _________________________
All
expenses of operating the vehicle
Were paid by: ………….The
Company_______ Me Personally________
******************
If any part of the operating expenses of this vehicle
were paid by you and you were not reimbursed for those expenses, complete Part
II.
PART II
Please enter on AMOUNTS
YOU PAID FOR WHICH YOU WERE NOT REIMBURSED.
Gasoline, Oil, Lubrication, etc. $ ___________________
Repairs
& Other
___________________
Washes
& Waxes
___________________
Parking
Fees & Tolls ___________________