PDR
Surplus Property
Property Disposal Request Form
Instructions:
Please fill out each section of this form completely. If you have questions about this form or the process, contact Material Services at 307-766-2409.
SECTION 1
SECTION 2
SECTION 3
Type of Disposition
Department Name:
The department certifies that all items listed below are clean of
chemical, biological and radioactive material.
Department Code:
Surplus Property
Contact Person:
Surplus Property will sanitize h ard drives to NIST.SP.800-88r1
Transfer of Property (Provide Department)
specifications or destroyed based on condition.
Contact Phone:
Other (Provide Reason)
I understand that Surplus Property will review requested
Are All Items Available for Pickup Immediately?
Yes
No
disposal price. If requested disposal price is left blank, Surplus
Additional Detail:
Property will determine market value/selling price. If it is
Date Available for Pickup:
determined it does not reflect the market they will work with
department to establish the basis for the sale price.
SECTION 4
Please enter as much information as possible about each item in the table below.
Grey areas are to be filled out by Surplus Property/Asset Management personnel only
Building
Room # /
Operational
Requested
Determined
Item
UW Tag #
Manufacturer
Model
Item Description (required)
Name
Location
(Y/N)
Disposal Price
Market Value
Destination
SECTION 5
Asset Management / Surplus Property Use Only
I authorize the items listed to be released to Surplus Property for sale, transfer, or disposal in accordance with
Date Received:
By:
existing policies.
Date Processed:
By:
Authorized signature must be from a Dean, Director, or Department Head.
AM Updated:
By:
Sponsored Programs Approval:
By:
PDR to Material Services:
By:
Print Name
Authorized Signature
Date
PDR to RMMC / Asset Mgt.
By:
Send This Form via UW Campus Mail, scanned into an email (property@uwyo.edu), or fax (307-766-6762) to UW
Notes:
Asset Management Office for approval. Pickup will be scheduled only after PDR approval.