Questionnaire for Business Use of Vehicles
Account Number: ____________________________
Business Name: _______________________________________________________________
Trade Name: _______________________________________________________________
Address Where Vehicles are stored: _______________________________________________
Please indicate the following information for each vehicle used in your business:
Registered Owner(s) and SSN or FIN: Percentage of Use:
Vehicle #1: ________________________________________________________________ _____________
Vehicle #2: ________________________________________________________________ _____________
Vehicle #3: ________________________________________________________________ _____________
Year, Make, and Model of vehicle:
Vehicle #1: ________________________________________________________________
Vehicle #2: ________________________________________________________________
Vehicle #3: ________________________________________________________________
License Plate Number or Title Number, if known:
Vehicle #1: ________________________________________________________________
Vehicle #2: ________________________________________________________________
Vehicle #3: ________________________________________________________________
(Complete additional form for additional vehicles.)
If the vehicle(s) is registered to an individual, please answer the following questions:
• Is more than 50% of the mileage for the year used as a business expense for Federal Income Tax purposes OR reimbursed by
an employer? Vehicle #1 _____ Vehicle #2 _____ Vehicle #3 ______
• Is more than 50% of the depreciation associated with the vehicle deducted as a business expense for Federal Income Tax
purposes? Vehicle #1 _____ Vehicle #2 _____ Vehicle #3 ______
• Is the cost of the vehicle expensed pursuant to Section 179 of the Internal Revenue Service Code?
Vehicle #1 _____ Vehicle #2 _____ Vehicle #3 ______
• Is the vehicle leased by an individual and the leasing company pays the tax without reimbursement from the individual?
Vehicle #1 _____ Vehicle #2 _____ Vehicle #3 ______
I certify that the above indicated information is true and correct, to the best of my knowledge.
____________________________________________ _____________________
Signature Date
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