2017 Brush Road Corporation Driver Declaration Form


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Address
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Brush Road Corporation
21105 Brush Road
Los Gatos, CA 95033

Dear Sirs:

During the calender year 2017, we have had an average of licensed driver(s) at our property. Hence our Base Fee is:
( 0 Drivers * (0 + 250) feet * $ 0.0325 dollars per foot ) + $ 280 Fixed Cost = $ 280.00

For months of this Year, our guests or contractors made a total of trips to or from our property during the month (or extra trips per day).
( 0 Trips Each Month / 30 Days per Month) * ( ( 0 + 250 ) feet * $ 0.0325 dollars per foot ) * ( 0 Months / 12 Months per Year) = $ 0.00

In addition, because of construction or other reasons, we feel the use of the road by us or by our agents during the past twelve months warrants an extra payment of $ .

Therefore our total charge for calendar year 2017 is $280.00 + $ 0.00 + $ 0.00, which is $280.00.

Please bill us for this amount.

Sincerely