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![example of gaps in state fund mileage form](/pdf-forms/other/form-e3065/filling-out-form-e3065-part-1.webp)
Provide the necessary data in the Example Ejemplo, Maple San Francisco, Dr Sherman Oak San Francisco, mi x c, Total Parking andor Tolls attach, Total Public Trans Other, SIGNATURE FIRMA, PRINT NAME IMPRIMA SU NOMBRE, DATE FECHA, e Rev, and TOTAL REIMBURSEMENT area.
![step 2 to entering details in state fund mileage form](/pdf-forms/other/form-e3065/filling-out-form-e3065-part-2.webp)
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