Ad Form 112 - Report Of Unserviceable, Lost, Stolen Damaged Or Destroyed Property

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U.S. DEPARTMENT OF AGRICULTURE

PROPERTY REPORT NO.

DATE

REPORT OF UNSERVICEABLE, LOST, STOLEN

DAMAGED OR DESTROYED PROPERTY

SECTION I - ACCOUNTABLE PROPERTY OFFICER'S REPORT

1. STATUS OF PROPERTY (Check only one-report each one type separately)

2. REPORTING ACTIVITY (Show agency, unit and address)

Unserviceable

Lost or Stolen

Obsolete

Cannibalized for parts

Damaged

Destroyed

Others

3. PROPERTY ITEMS (See attachment for additional entries)

ITEM DESCRIPTION AND OTHER DETAILS, INCLUDING

EXPLANATION/DISPOSAL INSTRUCTIONS

QUANTITY

SERIAL NUMBERS AND ACQUISITION DATE

ACQUISITION COST

(If lost, stolen, or destroyed, give detail.

(Or property no.)

(Give present condition and estimated cost of repair)

Was this reported to proper authorities?)

4. NAME IN PRINT AND SIGNATURE

DATE

5. NAME IN PRINT AND SIGNATURE

DATE

OF CUSTODIAN

OF ACCOUNTABLE PROPERTY OFFICER

SECTION II - PROPERTY MANAGEMENT OFFICER'S REVIEW AND RECOMMENDATION

DETERMINATION FOR LOST, STOLEN, DAMAGED, OR DESTROYED PROPERTY

1. After due consideration of all known facts and circumstances in this case, it is determined that:

a. The loss, theft, damage or destruction did not result from employee negligence and any involved employees are hereby relieved of liability.

b. There appears to be gross negligence involved; therefore, the case returned to agency officials for appropriate action under the Debt Collection Act.

c. There appears to be negligence involved; therefore, the case is returned to agency personnel officials for consideration of disciplinary action.

2. NAME IN PRINT AND SIGNATURE OF PROPERTY MANAGEMENT OFFICER

3. DATE

SECTION III - AUTHORIZATION FOR CANNIBALIZATION, ABANDONMENT, OR DESTRUCTION OF UNSERVICEABLE PROPERTY

1. Unserviceable property listed above is hereby authorized for cannibalization, abandonment, or destruction in accordance with FPMR 101-45.9 based on any of the following

determinations as further explained in section I-3(D):

a. Property has no commercial value.

e. Property is uneconomical to repair/not needed by another

user and may be cannibalized for parts. (Cannibalization is

b. Health, safety, or security considerations require immediate

a form of use and property management regulations shall apply.

abandonment or destruction.

Remainder of property must be disposed of through

usual procedures.)

c. Costs of care and handling exceed expected small lot sales proceeds.

d. Regulation or directive requires abandonment or destruction.

2. SIGNATURE OF PROPERTY MANAGEMENT OFFICER