Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Part I, Vehicle Usage, indicate whether you used an employer-provided vehicle for personal travel between November 1, 2018 and October 31, 2019 by selecting 'Yes' or 'No.' If you choose 'No,' simply sign the certificate and submit it to the provided address.
3. If you selected 'Yes' in Part I, proceed to Part IIa or Part IIb to determine the valuation method for personal use of the vehicle.
4. For Part IIa, if you are using the Cents-Per-Mile Computation method, enter your personal mileage for each specified date range. The form will automatically calculate the total amount based on the entered mileage rate.
5. If you choose Method 2 in Part IIb, enter the number of one-way commutes and the charge per commute, which is set at $1.50. The form will calculate the total to be included in gross income automatically.
6. In Part III, fill in your personal information, including your name, employee ID number, unit/department name, phone, email, and the date. Don’t forget to sign the document.
7. After completing the form, save your changes. You can download, print, or share the form as needed.

Complete your certification form online today to ensure compliance with university requirements.