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Vehicle Provided by a Third Party - Business Mileage Log

Vehicle

Odometer Reading

Date of Trip
Date of Trip

Indicate the date of actual travel for business purpose.

 Destination
Destination

Indicate the destination of your business travel. You need not provide an actual address, but a location that includes city and state. You also need not indicate brief stops along the way.

 Business Purpose
Business Purpose

Briefly describe the business purpose of your travel. You may include one entry for round trip travel.

 Miles Driven
Total Miles Driven

The total of all business miles driven, round trip, for each destination
A value is required.Please use date format (mm-dd-yy).
Add Row Delete Row   Total Miles Driven
    Total Claim (Mileage Rate $0.27/mile)

I certify that the above record reflects the business use of the vehicle described above. The information I am providing will be used to reduce the lease value of the vehicle I am provided in connection with the services that I provide to CSULB.I may be reimbursed at the current applicable "standard mileage rate" for business miles claimed by attaching this log to the appropriately approved travel expense claim.

For mileage reimbursement: Attach completed Vehicle Provided by a Third Party- Business Mileage Log to the applicable University Travel Expense Claim and forward to Accounts Payable, Fdn. 280 or CSULB Foundation Mileage Claim Form and forward to Fdn.332

Signature

Instructions

The University will allow you to reduce the annual lease value by your business use if an adequate record of your business use is obtained. Your business mileage log must be received by the 3rd of every month (attach additional pages if necessary) in order to elect the reduction for business use.

Your business mileage log must be sent to:

Beth Ryan
Director
Human Resources Services Group
Brotman Hall, Room 358
1250 Bellflower Blvd.
Long Beach, CA 90840
Mail Stop: 0124
Phone: (562)985-1741
Fax: (562)985-1821
Email:

In the event that you do not provide acceptable documentation the total monthly amount based on IRS annual lease value will be included in your wages.

If you have any questions regarding the taxation of this benefit, please contact: