Business Use of University-owned Vehicle

Report for the Period from

through

Driver Name:

Department:

As a driver of a Bryant University-owned vehicle, you are required by the University and IRS to provide the following information to the Controller’s Office. This information will be used to calculate and include additional income amounts reflected in paychecks you receive in the month this report is submitted. This information must also be provided to this office upon employees’ separation from Bryant.

Please provide the Controller’s Office with the following information by March 10, June 10, September 10, and December 10:

1. Year & Make of Auto:

2. License Plate #:

3. Beginning Mileage:

4. Ending Mileage:

5. Total Miles Driven:

6. Business Miles Driven:

7. Number of Months Employee drove this Vehicle during quarter: (Normally equal to 3 months unless a new vehicle was obtained sometime during the quarter. If so, please fill in another form for the new vehicle)

Please attach a copy of the business mileage logs along with this report.

Thank you for your cooperation. Feel free to call Susan Colantonio at Ext. 6006 if you have any questions.

 For Controller's Use Only