WPC  77WPC >?HtA ?6 @ ?KO"?Nmj?%{= ? =L<(d^oZ7>Z  (  (Untitled)'3,, , ,   UB ) 3    *    d +    d ,    d /0ghjklmnopqrstuvwxyz{|}~P* * f:\inf41\forms\ad728.wpf c:\temp\ad728.wpfUS&&&&&&&  >?Hf eh Terminal 1 ! ZS  d      Terminal eb Arial " ! <S  d    Arial ev Times New Roman  ! <S  d    Times New Roman ex Helvetica-Narrow " ! (5 S  d    Helvetica-Narrow eb Roman  ! 2L   d    Roman eh Helve-WP " ! <S  d     Helve-WP ej Wingdings  ! S  d     Wingdings eX  ! <S  d     eh MS Serif  ! <S  d     MS Serif ed Modern 2 ! x."  d    Modern ej Bodoni-WP  ! <S  d     Bodoni-WP er MS Sans Serif " ! FS  d    MS Sans Serif ed System " ! Z@   d    System er CG Times (WN)  ! <S  d    CG Times (WN) ef Courier 1 ! ZS  d     Courier en Univers ATT " ! FS  d     Univers ATT ep Times CG ATT  ! <S  d     Times CG ATT ep Arial Narrow " ! (5 S  d     Arial Narrow en Courier New 1 ! PL5    d      Courier New ?gAd A{?6z jV c:\inf41\database\ AD728.DBFHISTORY   i'Agency  <   h AGENCY< i2Organization_Unit  <   h  ORGANIZAT1< i.Name_Employee  <   h  NAME_EMPL2< i1Occepation_Title  <   h  OCCEPATIO3< i&Addr1  <   h ADDR1< i&Addr2  <   h ADDR2< i&Addr3  <   h ADDR3< i.Station_Addr1  <   h  STATION_A7< i.Station_Addr2  <   h  STATION_A8< i.Station_Addr3  <   h  STATION_A9< i1Residence_To_Ofc     h  RESIDENC10 i4Residence_To_Govern     h  RESIDENC11 i0Daily_Tour_Duty  #   h  DAILY_TO12# i,Home_to_Ofc  (   h  HOME_TO_13( i&Box_A      h BOX_A  i&Box_B      h BOX_B  i&Box_C      h BOX_C  i%Box1      h BOX1  i%Box2      h BOX2  i%Box3      h BOX3  i%Box4      h BOX4  i%Box5      h BOX5  i&Box_D      h BOX_D  i&Box_E      h BOX_E  i,Description      h  DESCRIPT24  i,Period_From     h  PERIOD_F25 i*Period_To     h PERIOD_TO i&Owned      h OWNED  i'Leased      h LEASED  i-Type_Vehicle      h  TYPE_VEH29  i.Employee_Sign  K   h  EMPLOYEE30K i/Employee_Dated     h  EMPLOYEE31 i-Approved_Yes  !    h  APPROVED32  i,Approved_No  "    h  APPROVED33  i.Approved_Sign # ,   h  APPROVED34, i/Approved_Title  $    h  APPROVED35  i.Approved_Date %    h  APPROVED36 i2Auth_Approved_yes  &    h  AUTH_APP37  i1Auth_Approved_No  '    h  AUTH_APP38  i4Expalin_Disapproved  (    h  EXPALIN_39  i3Authorization_Sign ) ,   h  AUTHORIZ40, i4Authorization_Title  *    h  AUTHORIZ41  i3Authorization_Date +    h  AUTHORIZ42 ?@d @}?KOb  ( Request and Authorization  ( For Home to Work Transportation % !"#                             P  h&&&    M0  1. AGENCY0 Agency!"-./5*67$89:$;>?@ABCG                         P #      $      ' <  Y@$.,! *  < &&&& = &&&    e 0  2. ORGANIZATIONAL UNIT0 Organization_Unit!"-./5*67$89:$;>?@ABCG                         P #      $      ' <  Y@$.,! *  < &&&& = &&&    ^b  3. NAME OF EMPLOYEEb Name_Employee!"-./567%89:%;>?@ABCG                         P #      $      ' <  Y@$.,! *  < &&&& = &&&    d0  4. OCCUPATION OR TITLE0 Occepation_Title!"-./5*67$89:$;>?@ABCG                         P #      $      ' <  Y@$.,! *  < &&&& = &&&     @b  Resident_Address#$( ),-.%/012456789                                    P ! b"Y$%$&')*                    <  Y@$.,!  ( &&& 3 &&&&    A     A     A     A     ?b$    Pb  5. RESIDENT ADDRESS"$%$&')*                     <  Y@$.,!  ( &&&    2bAddr1"$%$&')*                    <  Y@$.,!  ( <&&    2bAddr2"$%$&')*                    <  Y@$.,!  ( <&&    2bAddr3" $%$&')*                    <  Y@$.,!  ( <&&    @0  Ofc_Station#$( ),*-.$/012456789                                    P ! b" $%$&')*                    <  Y@$.,!  ( &&& 3 &&&&    A     A     A     A     ?0#    P0  6. OFFICIAL STATION" $%#&')*                     <  Y@$.,!  ( &&&    :0Station_Addr1"$%#&')*                    <  Y@$.,!  ( <&&    :0Station_Addr2"$%#&')*                    <  Y@$.,!  ( <&&    :0Station_Addr3"$%#&')*                    <  Y@$.,!  ( <&&    ` "  7. DISTANCES TRAVELED FROM:  I !"#                             P  &&&&    n( ,  a.   !"#                             P  &&&    (   Residence to   Office   !"#      Z                       P  &&    @T L Residence_To_Ofc!"-./567 89:;>?@ABCG                         P #      $      '   Y@$.,! *  < &&&& = <&&    n( ,  b.   !"#                             P  &&&    (   Residence to nearest Govern-   ment or Commercial storage   facility offering service during   required hours.   !"#      U                       P  &&    C , Residence_To_Govern!"-./56789:;>?@ABCG                         P #      $      '   Y@$.,! *  < &&&& = <&&    n( ,  c.   !"#                             P  &&&    <n(    Daily tour of duty -   Give each location starting with   first departure (Home or office,   plant, establishment, etc.) and   mileage between each point.    !"#      Z                       P  &&    ? .  Daily_Tour_Duty! "-./56789:;>?@ABCG                         P #      $      ' #  Y@$.,! *  < &&&& = <&&    p( ,,  i.e. 2  !"#                             P  &&&    ( N    Home to office-3 miles   Office to field   station - 10 miles   Field station to   area office 4 miles. 5  !"#      Z                       P  &&    ; z  Home_to_Ofc! "-./526789:;>?@ABCG                         P #      $      ' (  Y@$.,! *  < &&&& = <&&     "  8. REASON FOR HOME TO WORK TRANSPORTATION I !"#                             P  &&&&      a.  d dBox_A #$%&'()+,-.                             P   !  *  1  2      3     ~!   An immediate or imminent clear and present danger presents a threat to the physical safety of the employee's person or property. (Describe.)  F !"#                             P  &&&    n  b.  d dBox_B #!$%&'()+,-.                             P   !  *  1  2      3     ~n"  An emergency has created an immediate, unforeseeable temporary need to provide home-to-work transportation in order to guarantee   uninterrupted performance of the agency's mission. (Describe the nature of the emergency and the role of the employee to the agency's   mission.)  C !"#      Z                       P  &    0  c.  d dBox_C ##$%&'()+,-.                             P   !  *  1  2      3     ~0 $  Compelling operational considerations make the provision of home-to-work transportation essential to the conduct of official business or would   substantially increase the agency's efficiency or economy. (Describe the circumstances and/or explain how other available alternatives would   involve substantial additional costs to the Government or expenditures of employee time.)  F !"#      Z                       P  $    &  (1)  d dBox1#&$%&'()+,-.                             P   !  *  1  2      3     F'  Stationed at a field point with no office and normally proceed directly from residence to varying points of duty.  ? !"#                             P  &&&    &  (2)  d dBox2#($%&'()+,-.                             P   !  *  1  2      3     ?O?NF)  Stationed at a field point with local office, but normally proceed directly from residence to varying points of duty.  ? !"#                             P  &&&    &  (3)  d dBox3#*$%&'()+,-.                             P   !  *  1  2      3     KF +  Frequently required to depart on, and return from, field trips at unusually early or late hours, during which the use of public transportation or   services of other storage facilities are not available or reasonable.  D !"#      Z                       P  &$    J&  (4)  d dBox4#,$%&'()+,-.                             P   !  *  1  2      3     FJ-  Engaged in law enforcement duties under 31 U.S.C. 1344.  , !"#                             P  &&&    &  (5)  d dBox5#.$%&'()+,-.                             P   !  *  1  2      3     F|/  Storage of vehicle at residence due to economical or security reasons.  - !"#                             P  &&&      d.  d dBox_D#0$%&'()+,-.                             P   !  *  1  2      3     q~ 1  Field Work.   !"#                             P  &&&    >  e.  d dBox_E#2$%&'()+,-.                             P   !  *  1  2      3     ~>z 3  Residence is permanent Official Duty Station.   !"#                             P  &&&    O"L  DESCRIPTION:" Description!"-6./567I89:I;>?@ABCG                         P #      $      '  y  Y@$.,! *  < &&& = &&    R"7  9. AUTHORIZATION PERIOD $I !"#                             P  &&&&    P   From: Period_From!"-8./56%789:;>?@ABCG                         P #      $      ' +  Y@$.,! *  < &&&& = &&&    9@HASVALUE (Period_From) and #UPDATONLY  "  Period_From  ~      >@datevalue (@datetext (Period_From, "%2-%1-%5")) "  Period_From   %2-%1-%5  "  #  ;@VALUE (@DATETEXT (Period_From,"%5"))<=29 "  Period_From   %5  "  x         @SETVALUE (Period_From, @DATEVALUE (@CONCAT (@DATETEXT (Period_From,"%2-%1"),"-20",@DATETEXT (Period_From,"%5"))),TRUE) $  Period_From "  Period_From   %2-%1  "   -20 "  Period_From   %5  "      #       L<  To: Period_To!"-9./5 6%7/89:;>?@ABCG                         P #      $      ' +  Y@$.,! *  < &&&& = &&&    7@HASVALUE (Period_To) and #UPDATONLY     Period_To  ~      <@datevalue (@datetext (Period_To, "%2-%1-%5"))    Period_To   %2-%1-%5  "  #  9@VALUE (@DATETEXT (Period_To,"%5"))<=29    Period_To   %5  "  x         @SETVALUE (Period_To, @DATEVALUE (@CONCAT (@DATETEXT (Period_To,"%2-%1"),"-20",@DATETEXT (Period_To,"%5"))),TRUE) "  Period_To    Period_To   %2-%1  "   -20    Period_To   %5  "      #          Owned  d dOwned#:$%&('()+,-.                             P   !  *  1  2      3     Owned=TRUE   Owned           @RESETOBJ (Leased)   Leased     l   Leased  d dLeased#;$%&)'()+,-.                             P   !  *  1  2      3     Leased=TRUE   Leased          @RESETOBJ (Owned)   Owned    ~rX  Type of vehicle (Describe: i.e., sedan, truck, etc.) Type_Vehicle!"-<./56(7A89:A;>?@ABCG                         P #      $      '  k  Y@$.,!. *  < &&&& = &&    "=  10. VEHICLE IDENTIFICATION 'I !"#                             P  &&&&    !">  11. CERTIFICATION (See Privacy Act Statement) +I !"#                             P  &&&&    ": ?  I CERTIFY that the above information is true and correct to the best of my knowledge. I will not use this vehicle at any time for my personal   convenience or permit others to do so. When parked at or near residence, vehicle will be kept locked and every precaution taken to guard it   against damage or theft, etc. I understand that use of this vehicle for other than official purposes makes me subject to suspension without pay   for a period of not less than one month or to removal summarily from office as provided in 31 U.S.C. 1349 (b).  ,D !"#                             P  &&&&    `N%  SIGNATURE OF EMPLOYEEl Employee_Sign!"-@./56/7=89:;>?@ABCG                         P #      $      ' K  Y@$.,! *  < &&& = &&&    YN%  DATE SIGNED Employee_Dated!"-A./5C6/7 89: ;>?@ABCG                         P #      $      '   Y@$.,! *  < &&&& = &&&    <@HASVALUE (Employee_Dated) and #UPDATONLY  %  Employee_Dated  ~      A@datevalue (@datetext (Employee_Dated, "%2-%1-%5")) %  Employee_Dated   %2-%1-%5  "  #  >@VALUE (@DATETEXT (Employee_Dated,"%5"))<=29 %  Employee_Dated   %5  "  x         @SETVALUE (Employee_Dated, @DATEVALUE (@CONCAT (@DATETEXT (Employee_Dated,"%2-%1"),"-20",@DATETEXT (Employee_Dated,"%5"))),TRUE) '  Employee_Dated %  Employee_Dated   %2-%1  "   -20 %  Employee_Dated   %5  "      #       ~&"B I 12. RECOMMENDATION 1I !"#                             P  &&&&    t'C a APPROVED 2 !"#                             P  &&&&    <(  Yes  d dApproved_Yes#D$%&3'()+,-.                             P   !  *  1  2      3     #Approved_Yes=TRUE #  Approved_Yes          %@RESETOBJ (Approved_No) $  Approved_No    <(  No  d dApproved_No#E$% &3'()+,-.                             P   !  *  1  2      3     "Approved_No=TRUE "  Approved_No          &@RESETOBJ (Approved_Yes) %  Approved_Yes    T'   SIGNATURE Approved_Sign!"-F./562789:;>?@ABCG                         P #      $      ' ,  Y@$.,! *  < &&&& = &&&    Q'   TITLE Approved_Title! "-G./5)62789:;>?@ABCG                         P #      $      '  ,  Y@$.,! *  < &&& = &&&    ?i?%Q'  DATE Approved_Date!!"-H./5C627 89: ;>?@ABCG                         P #      $      '   Y@$.,! *  < &&&& = &&&    ;@HASVALUE (Approved_Date) and #UPDATONLY  $  Approved_Date  ~      @@datevalue (@datetext (Approved_Date, "%2-%1-%5")) $  Approved_Date   %2-%1-%5  "  #  =@VALUE (@DATETEXT (Approved_Date,"%5"))<=29 $  Approved_Date   %5  "  x         @SETVALUE (Approved_Date, @DATEVALUE (@CONCAT (@DATETEXT (Approved_Date,"%2-%1"),"-20",@DATETEXT (Approved_Date,"%5"))),TRUE) &  Approved_Date $  Approved_Date   %2-%1  "   -20 $  Approved_Date   %5  "      #       }h)"I  13. AUTHORIZATION 5I !"#                             P  &&&&    t0*XJ a APPROVED 6 !"#                             P  &&&&     \+  Yes  d dAuth_Approved_yes"#K$%&7'()+,-.                             P   !  *  1  2      3     (Auth_Approved_yes=TRUE (  Auth_Approved_yes          *@RESETOBJ (Auth_Approved_No) )  Auth_Approved_No    \+  No  d dAuth_Approved_No##L$% &7'()+,-.                             P   !  *  1  2      3     'Auth_Approved_No=TRUE '  Auth_Approved_No          +@RESETOBJ (Auth_Approved_yes) *  Auth_Approved_yes    d0*X  Explain Disapproval Expalin_Disapproved!$"-M./5667A89:A;>?@ABCG                         P #      $      '  ,  Y@$.,! *  < &&&& = <&&    Y,X  SIGNATURE Authorization_Sign!%"-N./5697#89:#;>?@ABCG                         P #      $      ' ,  Y@$.,! *  < &&&& = &&&    V, X  TITLE Authorization_Title!&"-O./5)69789:;>?@ABCG                         P #      $      '  ,  Y@$.,! *  < &&&& = &&    V,X  DATE Authorization_Date!'"-P./5C697 89: ;>?@ABCG                         P #      $      '   Y@$.,! *  < &&&& = &&&    @@HASVALUE (Authorization_Date) and #UPDATONLY  )  Authorization_Date  ~      E@datevalue (@datetext (Authorization_Date, "%2-%1-%5")) )  Authorization_Date   %2-%1-%5  "  #  B@VALUE (@DATETEXT (Authorization_Date,"%5"))<=29 )  Authorization_Date   %5  "  x         @SETVALUE (Authorization_Date, @DATEVALUE (@CONCAT (@DATETEXT (Authorization_Date,"%2-%1"),"-20",@DATETEXT (Authorization_Date,"%5"))),TRUE) +  Authorization_Date )  Authorization_Date   %2-%1  "   -20 )  Authorization_Date   %5  "      #       ."Q  This authorization is not transferable. A new application must be submitted whenever the circumstances, as started above, change to such an   extent as to make continued authority questionable. The approving officer should be notified immediately when for any reason (such as   transfer, separation, etc.) this authority is no longer required. <I !"#      Z                       P  |&&&    `"0^R n Form AD-728  n Rev. 12/88 I> !"#                             P  &&&    00 Z d This form was electronically produced by Elite Federal Forms,  d Inc. > !"#                            <  &&    ?.= def =c? {,T ( PRIVACY ACT STATEMENT  C !"#                             P  &&&&    :&V  AUTHORITY: The authority to collect personal information on this form is derived from Title 5 U.S. Code, Section 301   and 31 U.S.C. 1349(b).   C !"#      n                       P  &&&&    $ LW  PURPOSE: The principle purpose for soliciting personal information on this form is to formally document the private   residence for which the authorization to store a government owned or leased motor vehicle is being requested. The   information establishes a legal basis for personnel or financial actions which might result from use of a government   owned or leased motor vehicle in a nonofficial capacity.   C !"#      n                       P  &&&&    wRX  EFFECTS OF NONDISCLOSURE: The disclosure of this information is voluntary, however, failure to furnish the   information may result in the disapproval of a request to store a government owned or leased motor vehicle at or near   a private residence.  C !"#      n                       P  &&&&    ?=d =<(defg h <D^o elite10.DLL IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. elite10.COM IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. WPIN$ELITE10FunctionSet,4.1 ^=ZP4{ZP