Property Disposition Request Form
| Department Name | Contact Name | Phone Ext. | Email Address |
PLEASE CHECK THE APPROPRIATE TRANSACTION BOX
⧠ Transfer ⧠ Sale ⧠ Disposal
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Asset No. |
Serial No. |
Value |
Asset Description (item, age, condition) |
Building Location |
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Disposition (Check box): ⧠ Sold ⧠ Stolen/Missing ⧠ Scrapped ⧠ Trade-In
⧠ Other – explain:
_______________________________ ______________ _____________________________ ______________
Contact’s Signature Date Facility Director Signature Date
________________________________ ______________ _______________________________ ______________
Chief Executive Director Signature Date Business Account Specialist Signature Date
Data Removed (If Applicable): ⧠ Yes ____________________________ ______________
Technology Coordinator Date
Disposal Form #: __________ Funds Received: ___________