Surplus Property Declaration Form printable pdf download

Surplus Property Declaration Form

Please use this form when declaring any item of value as surplus.

Use a separate form for each capital item over $5000.

FILLED OUT BY SURPLUS PROPERTY MANGER

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Method of Disposal:

________ Another State Agency ________ Public Sale ________ Landfill or Salvage Yard

Receipt # ______________________ Date ______________________ Amount Received

___________________

Surplus Manager's Signature___________________________________________________________

Date_____________________

FILLED OUT BY DEPARTMENT

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Reason for Declaring Surplus:

Replace with new or similar technology

Obsolete, no replacement, or junk (please call 8061 to inspect before discarding)

Trade-in

Item(s) Descritpion:

If more items, please use a separate sheet to list all items.

Department Head Signature:___________________________________________________________

Date: ___________________

PLEASE PROVIDE THE FOLLOWING INFORMATION FOR CAPITAL

INVENTORY ITEMS(THOSE ITEMS WHOSE ORIGINAL COST WAS $5000 OR

MORE)Send a copy to Jeffrey Kahler, Old Main 201, so the item can be removed from

capital inventory

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Surplus Property Declaration Form