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Application for Permanent Assignment of Passenger Vehicle

Person Assigned to or Responsible for the Vehicle
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: 
Vehicle Usage:   
Department or Institution Information
Company:     Fund No.:    Center No.: 
Division, Office or Agency Information
Phone No:  Ext:     
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.: