AC 160 (Rev. 4/82) 			STATE OF NEW YORK
				  STATEMENT OF AUTOMOBILE TRAVEL
				(Submit with travel expense voucher)  		.................  
										 Subvoucher No.  

			....................................................  
			      (Department, Commission or Other Agency)  	.................
										    Sheet No.

			PAYEE ..............................................


	Between What Points	Meals	Hour of Departure	Hour of Arrival		Miles
Date	From  	To   		Only*   A.M.	P.M.  		A.M.   P.M.   		Traveled
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									Total Miles:	
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*Enter meals not included in per diem; B for breakfast, D for dinner.

I hereby certify that the travel indicated was necessary and on official business of the State.  


								_________________________________
								      Signature of Traveler  

					     osc COPY