EMPLOYEE SUPPLEMENTAL COMPENSATION FORM
Date:
Prepared By
Dept
Employee Name
Mail Code
Tel Ext
__________
Position Number
Account Number
The following represents NON-cash compensation to the employee that will not generate pay.
The non-cash compensation will generate a tax liability for the employee and, in most instances,
also for the employer for the current tax year W-2.
Auto – Declaration of Personal Use (Use a separate form for each vehicle if you used more than
one vehicle during the calendar year.)
Date You Received the Vehicle
Date You Turned in the Vehicle
Vehicle (Make/Model)
Market Value of Vehicle
Percentage of Personal Use
Employee Signature
Taxable Amount
Date
Reporting Dept Representative
DATE BENEFIT
RECEIVED
AMOUNT
EMPLOYEE EDUCATION (GIA)
EVENT TICKETS
MOVING ALLOWANCE
TRAVEL COMPENSATION
NON-TAXABLE MOVING EXP
OTHER
Date
REF DOC