DEPARTMENT OF ADMINISTRATION Motor Fleet …FM-12e STATE OF NORTH CAROLINA Total Miles DEPARTMENT OF...

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FM-12e STATE OF NORTH CAROLINA Total Miles DEPARTMENT OF ADMINISTRATION Rate per Mile Motor Fleet Management Division, Raleigh Mileage Charge TRAVEL LOG Monthly Fee $35.00 FOR PERMANENTLY ASSIGNED VEHICLES Total Amount Department Agency Dept./Off. No. Fund No. RCC No. Individual Responsible for Vehicle: Approval of Agency Head or Supervisor: Vehicle No. For Month Of TRIP DATES OFFICIAL TRAVEL MILEAGE Leave Return From To Purpose of Trip Signature Out In Miles No. of Trips No. of Trip Days Local Trips Odometer Readings: Beginning of Month End of Month

Transcript of DEPARTMENT OF ADMINISTRATION Motor Fleet …FM-12e STATE OF NORTH CAROLINA Total Miles DEPARTMENT OF...

Page 1: DEPARTMENT OF ADMINISTRATION Motor Fleet …FM-12e STATE OF NORTH CAROLINA Total Miles DEPARTMENT OF ADMINISTRATION Rate per Mile Motor Fleet Management Division, Raleigh Mileage Charge

FM-12e STATE OF NORTH CAROLINA Total Miles

DEPARTMENT OF ADMINISTRATION Rate per Mile

Motor Fleet Management Division, Raleigh Mileage Charge

TRAVEL LOG Monthly Fee $35.00

FOR PERMANENTLY ASSIGNED VEHICLES Total Amount Department Agency Dept./Off. No. Fund No. RCC No.

Individual Responsible for Vehicle: Approval of Agency Head or Supervisor: Vehicle No. For Month Of

TRIP DATES OFFICIAL TRAVEL MILEAGE Leave Return From To Purpose of Trip Signature Out In Miles

No. of Trips

No. of Trip Days Local Trips

Odometer Readings: Beginning of Month End of Month