Form C-33 "Personal Automobile Mileage and Pre-tax Parking Voucher" - Hawaii

What Is Form C-33?

This is a legal form that was released by the Hawaii Department of Accounting & General Services - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2001;
  • The latest edition provided by the Hawaii Department of Accounting & General Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form C-33 by clicking the link below or browse more documents and templates provided by the Hawaii Department of Accounting & General Services.

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Download Form C-33 "Personal Automobile Mileage and Pre-tax Parking Voucher" - Hawaii

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Form to be printed on Letter size (8 1/2 x 11) white paper.
STATE OF HAWAII
Verify: Page Scaling set as "Fit to Printer Margins" in Print menu.
PERSONAL AUTOMOBILE MILEAGE AND PRE-TAX PARKING VOUCHER
DOCUMENT
SUBMITTED BY
CONTROL NO.
MONTH OF
YEAR
(PRINT NAME)
DEPARTMENT/DIV.
SOCIAL SECURITY NO.
BRANCH/SECTION
POSITION TITLE
YEAR
MODEL
& MAKE
& TYPE
BU
PAYROLL NO.
SFX
TC
F
YR
APP
D
OBJECT
CC
PROJECT
PH
ACT
AMOUNT
OPTIONAL DEPARTMENTAL DATA
XX
XXX
X
XX
XXX
XX
XXXX
XXXX
XXXXXX
XX
XXX
XXXXXXXXXX
XX
X(22)
MONTH/
TRIP
MILES
PARKING
FROM
TO
REMARKS
DAY
NUMBER
TRAVELED
FEES
I CERTIFY THAT THE ABOVE IS A TRUE AND CORRECT RECORD OF MILEAGE ON MY PERSONAL
A. TOTAL MILEAGE
AUTOMOBILE USED AND PARKING FEES INCURRED IN PERFORMING MY OFFICIAL DUTIES
B. TOTAL MILEAGE CLAIM
ACCORDING TO THE COMPTROLLER'S RULES AND REGULATIONS GOVERNING OFFICIAL
44.5
(A X Rate:
cents)
TRAVEL AND TRANSPORTATION EXPENSES. I FURTHER CERTIFY THAT I CARRY THE MINIMUM
LIABILITY INSURANCE AS REQUIRED BY THE "HAWAII NO-FAULT LAW" WITH:
C. TOTAL PARKING FEES
D. TOTAL CLAIM FOR REIMBURSEMENT (B + C)
(INSURANCE COMPANY)
CALCULATION OF REPORTABLE & TAXABLE MILEAGE **
POLICY NO.
EXP. DATE
E. FEDERALLY ALLOWED AMOUNT
(L)
44.5
THIS IS TO ALSO CLAIM REIMBURSEMENT OF EXCESS PRE-TAX PARKING PAID
(A X Rate:
cents)
UNDER THE FLEX PARK PLAN FOR THE MONTH(S) OF:
.
F. TAXABLE AMOUNT (B-E)
(T)
(THIS ONLY APPLIES TO EMPLOYEES WHO QUALIFY FOR REDUCED PARKING RATES AS
PROVIDED UNDER COLLECTIVE BARGAINING AGREEMENT OR EXECUTIVE ORDER.)
TAXABLE PRE-TAX PARKING REIMBURSEMENT **
G. PRE-TAX PARKING REIMBURSEMENT
(T)
(EMPLOYEE'S SIGNATURE)
(DATE)
APPROVED:
(SIGNATURE
(DATE)
(TITLE)
** The taxable mileage amount calculated above and pre-tax parking reimbursement amount will be reported as income to the IRS and will result in the withholding of Federal, State, and
FICA taxes from gross payroll wages. Retain a copy of the form to prepare your personal tax return.
STATE ACCOUNTING FORM C-33
JANUARY 1, 2001 (REVISED) E
Form to be printed on Letter size (8 1/2 x 11) white paper.
STATE OF HAWAII
Verify: Page Scaling set as "Fit to Printer Margins" in Print menu.
PERSONAL AUTOMOBILE MILEAGE AND PRE-TAX PARKING VOUCHER
DOCUMENT
SUBMITTED BY
CONTROL NO.
MONTH OF
YEAR
(PRINT NAME)
DEPARTMENT/DIV.
SOCIAL SECURITY NO.
BRANCH/SECTION
POSITION TITLE
YEAR
MODEL
& MAKE
& TYPE
BU
PAYROLL NO.
SFX
TC
F
YR
APP
D
OBJECT
CC
PROJECT
PH
ACT
AMOUNT
OPTIONAL DEPARTMENTAL DATA
XX
XXX
X
XX
XXX
XX
XXXX
XXXX
XXXXXX
XX
XXX
XXXXXXXXXX
XX
X(22)
MONTH/
TRIP
MILES
PARKING
FROM
TO
REMARKS
DAY
NUMBER
TRAVELED
FEES
I CERTIFY THAT THE ABOVE IS A TRUE AND CORRECT RECORD OF MILEAGE ON MY PERSONAL
A. TOTAL MILEAGE
AUTOMOBILE USED AND PARKING FEES INCURRED IN PERFORMING MY OFFICIAL DUTIES
B. TOTAL MILEAGE CLAIM
ACCORDING TO THE COMPTROLLER'S RULES AND REGULATIONS GOVERNING OFFICIAL
44.5
(A X Rate:
cents)
TRAVEL AND TRANSPORTATION EXPENSES. I FURTHER CERTIFY THAT I CARRY THE MINIMUM
LIABILITY INSURANCE AS REQUIRED BY THE "HAWAII NO-FAULT LAW" WITH:
C. TOTAL PARKING FEES
D. TOTAL CLAIM FOR REIMBURSEMENT (B + C)
(INSURANCE COMPANY)
CALCULATION OF REPORTABLE & TAXABLE MILEAGE **
POLICY NO.
EXP. DATE
E. FEDERALLY ALLOWED AMOUNT
(L)
44.5
THIS IS TO ALSO CLAIM REIMBURSEMENT OF EXCESS PRE-TAX PARKING PAID
(A X Rate:
cents)
UNDER THE FLEX PARK PLAN FOR THE MONTH(S) OF:
.
F. TAXABLE AMOUNT (B-E)
(T)
(THIS ONLY APPLIES TO EMPLOYEES WHO QUALIFY FOR REDUCED PARKING RATES AS
PROVIDED UNDER COLLECTIVE BARGAINING AGREEMENT OR EXECUTIVE ORDER.)
TAXABLE PRE-TAX PARKING REIMBURSEMENT **
G. PRE-TAX PARKING REIMBURSEMENT
(T)
(EMPLOYEE'S SIGNATURE)
(DATE)
APPROVED:
(SIGNATURE
(DATE)
(TITLE)
** The taxable mileage amount calculated above and pre-tax parking reimbursement amount will be reported as income to the IRS and will result in the withholding of Federal, State, and
FICA taxes from gross payroll wages. Retain a copy of the form to prepare your personal tax return.
STATE ACCOUNTING FORM C-33
JANUARY 1, 2001 (REVISED) E