Form Temp Na 1228 - Notice Of Action Page 2

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PAYMENT CALCULATION
PAYMENT CALCULATION
PAYMENT CALCULATION
Month _______________ Year ________
Month _______________ Year ________
Month _______________ Year ________
Public transportation
Public transportation
Public transportation
_______ rate
_______ rate
_______ rate
_______ per _________
_______ per _________
_______ per _________
=$ ______
=$ ______
=$ ______
Your car’s mileage
Your car’s mileage
Your car’s mileage
_______ rate
_______ rate
_______ rate
______ per __________
______ per __________
______ per __________
=$ ______
=$ ______
=$ ______
Parking
Parking
Parking
=$ ______ month
=$ ______ month
=$ ______ month
school term
school term
school term
other
other
other
Other: ______________ -
Other: ______________ -
Other: ______________ -
9
_______ rate
_______ rate
_______ rate
x ______ per ________
x ______ per ________
x ______ per ________
=$ _______
=$ _______
=$ _______
PAYMENT CALCULATION
PAYMENT CALCULATION
PAYMENT CALCULATION
Month _______________ Year ________
Month _______________ Year ________
Month _______________ Year ________
Public transportation
Public transportation
Public transportation
_______ rate
_______ rate
_______ rate
_______ per _________
_______ per _________
_______ per _________
=$ ______
=$ ______
=$ ______
Your car’s mileage
Your car’s mileage
Your car’s mileage
_______ rate
_______ rate
_______ rate
______ per __________
______ per __________
______ per __________
=$ ______
=$ ______
=$ ______
Parking
Parking
Parking
=$ ______ month
=$ ______ month
=$ ______ month
school term
school term
school term
other
other
other
Other: ______________ -
Other: ______________ -
Other: ______________ -
_______ rate
_______ rate
_______ rate
x ______ per ________
x ______ per ________
x ______ per ________
=$ _______
=$ _______
=$ _______

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