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RELEASE OF PROPERTY ACCOUNTABILITY FORM Used for annual physical inventory only Accountable Department Chair/Director Date Department Name Department Code The above referenced Accountable Department Chair/Director requests relief from accountability for property described below. The Accountable Department Chair/Director is required to receive Environmental Health Safety certifications when items are contaminated or pose health hazards and certify their safety prior to removal* Item No* Property Tag No* Description Cost Disposition Number DISPOSITION 1. 2. 3. 4. 5. 6. 7. 8. 9. M issing Current Inventory L Stolen Issuer must attach a copy of Campus Police Report. Damaged or Destroyed Advise details by attachment. Removed by Environmental Health Safety Replaced by Other Equipment. Was item traded in Yes No PO /Bid Ref Cannibalized Equipment Attach copy of Inventory Request Form Surplus Equipment Transferred Equipment Not Owner of Equipment Belongs to Department Specify other I hereby certify that the above is a true and complete statement of reasons for the above request. The Accountable Department Chair/Director is required to receive Environmental Health Safety certifications when items are contaminated or pose health hazards and certify their safety prior to removal* Item No* Property Tag No* Description Cost Disposition Number DISPOSITION 1. 2. 3. 4. 5. 6. 7. 8. 9. M issing Current Inventory L Stolen Issuer must attach a copy of Campus Police Report. 2. 3. 4. 5. 6. 7. 8. 9. M issing Current Inventory L Stolen Issuer must attach a copy of Campus Police Report. Damaged or Destroyed Advise details by attachment. Removed by Environmental Health Safety Replaced by Other Equipment. Damaged or Destroyed Advise details by attachment. Removed by Environmental Health Safety Replaced by Other Equipment. Was item traded in Yes No PO /Bid Ref Cannibalized Equipment Attach copy of Inventory Request Form Surplus Equipment Transferred Equipment Not Owner of Equipment Belongs to Department Specify other I hereby certify that the above is a true and complete statement of reasons for the above request. The Accountable Department Chair/Director is required to receive Environmental Health Safety certifications when items are contaminated or pose health hazards and certify their safety prior to removal* Item No* Property Tag No* Description Cost Disposition Number DISPOSITION 1. 2. 3. 4. 5. 6. 7. 8. 9. M issing Current Inventory L Stolen Issuer must attach a copy of Campus Police Report. Damaged or Destroyed Advise details by attachment. Removed by Environmental Health Safety Replaced by Other Equipment. 2. 3. 4. 5. 6. 7. 8. 9. M issing Current Inventory L Stolen Issuer must attach a copy of Campus Police Report. Damaged or Destroyed Advise details by attachment. Removed by Environmental Health Safety Replaced by Other Equipment. Was item traded in Yes No PO /Bid Ref Cannibalized Equipment Attach copy of Inventory Request Form Surplus Equipment Transferred Equipment Not Owner of Equipment Belongs to Department Specify other I hereby certify that the above is a true and complete statement of reasons for the above request.

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