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Application for Permanent Assignment of Passenger Vehicle
Vehicle Information for Changed Information
Vehicle No.:  License No.: 
Year:  Make:  Model: 
Mileage: 
Statement about Why Change is being made
(eg:name change, new employee, change of job, etc.
Person Assigned to or Responsible for the Vehicle
Name: 
Drivers License No.:  State Driver's License Issued From: 
Position Title: 
Work Phone No:  Ext: 
Work Mailing Address: 
 (if working from home, enter home address)
Work City:    Zip:  Courier/MSC: 
Email: 
Vehicle Usage: 
Department or Institution Information
Department: 
Company:   Fund No.:  Agency Management Unit:  Agency Program:  Funding Source:  Project: 
Division, Office or Agency Information
Name: 
Phone No:  Ext: 
Address: 
City:   Zip:  Courier/MSC: 
Address Vehicle Will be Parked:  City:
County Vehicle Will be Parked: 
Additional Information
Section(if applicable): 
District(if applicable): 
Vehicle Needs
Date Needed(mm/dd/yyyy): 
How Long Needed: 
Expected Yearly Mileage Use: 
Why Vehicle is Needed and
How it Will be Used: 
Type Vehicle Needed: 
Commuter Information
Office In home?
Only complete if Office is not in home and individual qualifies to drive vehicle home.
How do they qualify to drive vehicle home?
Reason driver required to drive after duty hours.
Round trip distance to driver's residence.
Position No.: