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.

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

PAYROLL NO.

SFX

APP

OBJECT

PROJECT

ACT

AMOUNT

OPTIONAL DEPARTMENTAL DATA

XXX

XXXX

XXXXXX

XXX

XXXXXXXXXX

X(22)

MONTH/

TRIP

MILES

PARKING

FROM

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

PAYROLL NO.

SFX

APP

OBJECT

PROJECT

ACT

AMOUNT

OPTIONAL DEPARTMENTAL DATA

XXX

XXXX

XXXXXX

XXX

XXXXXXXXXX

X(22)

MONTH/

TRIP

MILES

PARKING

FROM

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