perq appvls 09 2006 by 96FdgP

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									                   DEPARTMENT OF MANAGEMENT SERVICES
                 DIVISION OF HUMAN RESOURCE MANAGEMENT

           PERQUISITE APPROVALS REPORT
AGENCY NAME:
PREPARED BY:
PHONE and E-MAIL:
FOR FISCALYEAR:
Please list the cost for each Perquisite category within the fiscal year
shown above.
 PERQUISITE                          PERQUISITE                                     TOTAL
    CODE                             DESCRIPTION                                    COST
     A10      Paid Parking
     B10      Barber or Beautician Services
     D10      Formal Wear - Rental
     D20      Fire and Arson Investigator Uniform
     D30      Clothing - Personal, Without Shoes, No Allowances or
     D40      Clothing - Identification
     D50      Clothing - Other Sworn Law Enforcement
     D60      Clothing - Specialty Vest
     D70      Clothing - Laboratory Protective Outer Wear
     D71      Clothing - Service Protective Outer Wear
     D80      Clothing - Law Enforcement Plain Clothes With Shoe
     E10      Equipment - Safety Prescription Glasses
     E20      Equipment - Diving Gear
     E30      Equipment - Individual Specialty Footwear
     E40      Equipment - Safety Equipment
     F10      Telephone Service
     G10      Transportation
     H10      Housing - All Utilities Provided
     H11      Housing - Partial Utilities Provided
     H12      Housing - No Utilities Provided
     H20      Mobile Home Space - All Utilities Provided
     H21      Mobile Home Space - Partial Utilities Provided
     H22      Mobile Home Space - No Utilities Provided
     I10      Cash Allowance - Other
     I20      Cash Allowance - Personal Property Replacement
     J10      Law Enforcement Vehicle, Uniform, Equipment - Off Duty
     L10      Licenses
     L20      H-1B Nonimmigrant Worker Employer Filing Fee
    M10       Meals
     P10      Physicals/Immunizations
     U10      Uniform - With Shoes, No Allowances
     U11      Uniform - With Shoes, With Shoe Allowance
     U12      Uniform - With Shoes, With Uniform Allowance
     U13      Uniform - With Shoes, With Laundry Allowance
     U14      Uniform - With Shoes, With Uniform and Shoe Allowance
     U15      Uniform - With Shoes, No Allowances or Laundry Service
     U20      Uniform - With boots, No Allowances
     U21      Uniform - With Boots, With Boot Allowance
     U23      Uniform - With Boots, With Laundry Service
     U30      Uniform - Without Shoes, No Allowances
     U32      Uniform - Without Shoes, With Uniform Allowance
     U33      Uniform - Without Shoes, With Laundry Service
     U34      Uniform - Without Shoes, With Uniform and Shoe
     U35      Uniform - Without Shoes, No Allowances or Laundry
                                                          AGENCY TOTAL:

                              Page 1 of 5   d4b3b9ce-9710-4090-a012-46de7d80d2b5.xls Rev. 09/2006
             DEPARTMENT OF MANAGEMENT                                               HUMAN RESOURCE MANAGEMENT

              SERVICES                                                  PAYMENT OF MOVING EXPENSES
AGENCY:
PREPARED BY:                                                                                                               PHONE:
FOR FISCAL YEAR:

Please list the following information for each employee for whom your agency paid moving expenses in the fiscal year shown above.

                                                              DATE            CITY              CITY               *                          DATE
EMPLOYEE'S NAME                    CLASS TITLE               MOVED         MOVED FROM         MOVED TO          POUNDS         COST         APPROVED




                                                                                                                                       $0
* N/A IF COMMON CARRIER IS NOT USED

                                                                     Page 2of 5                   d4b3b9ce-9710-4090-a012-46de7d80d2b5.xls Rev. 01/2002
                                 DATE            CITY        CITY              *                          DATE
EMPLOYEE'S NAME   CLASS TITLE   MOVED         MOVED FROM   MOVED TO         POUNDS         COST         APPROVED




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