Automobile Use Mileage Log Template
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1
2Boise State University
Automobile Use Mileage Log (Documentation for Business Miles)
Check appropriate box for this submission:
Employee Name (PRINT): ______________________________________________ ___________________
□
□
st
rd
1
Quarter Dec–Feb (due to payroll by 3/5)
3
Quarter Jun – Aug (due to payroll 9/5)
□
□
nd
th
2
Quarter Mar–May (due to payroll by 6/5)
4
Quarter Sep – Nov (due to payroll 12/5)
Title: ____________________________________________________________________________________
OR
Dept. __________________________________________________________ Ext. ____________________
□
I elect to treat the entire benefit as taxable compensation. (If this box is selected, you must
submit this form to Payroll by Dec 1 annually. Tax due on this benefit will be deducted bi-
Signature: _____________________________________________________ Date: _________________
weekly from your paycheck over the course of the year.)
Date
Starting
Ending
Business
Destination
Business Purpose
Odometer
Odometer
Miles
EXAMPLE 1
28
38
10
Plantation
Golf with Joe Smith, CEO of Joe's Sports, to discuss expectations for $100,000 donation for E. Jr. High
8/19/09
project.
EXAMPLE 2
55
57
2
Arid Club
Dinner with potential donor, John Smith, alum and owner of John's Real Estate Co., to discuss potential
8/20/09
stadium naming rights.
EXAMPLE 3
61
64
3
XYZ Restaurant
Interview lunch with Jane Jones, candidate for women's basketball assistant position.
8/21/09
Rev. 03/10
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