HomeMy WebLinkAbout6-a.2.a Asset Disposal AGENDA ITEM 6-a.2.a
REQUEST FOR SURPLUS DECLARATION AND/OR
ASSET DISPOSAL AUTHORIZATION
04/19/22
Asset Number Description Acquired Date Cost Per Unit Book Value
9159 WASHER FOR HURRICANE PREPAREDNESS 10/1/2004 $ 868.00 $ -
Clay County Utility Authority
Equipment Update Form
Disposal/Surplus Section:
❑■ Dispose ❑Surplus Placement ❑ Surplus Removal
Placement Location:
(If Requesting Disposal, please indicate reason below)
❑ Lost ❑Obsolete Date Agenda Approved
❑ Cannibalized ❑Stolen / Vandalized *
❑■ Damaged ❑Returned to Vendor
* If Stolen / Vandalized, please provide a copy of the police report.
Asset # Item Description (Make/Model) Serial #
9159 Washing Machine N/A
Dept Name: FAC Requested by: Tracy Alexander
Dept Head Approval: Date: 4/12/2022
Final Disposal Details
Method of Disposal: Me Du ster Date: 4/12/2022
Details/Comments:
Person Disposing: Jim Moore Date: 4/12/2022
Witness: Tracy Alexander Date: 4/12/2022
Transfer/Loan Section (Between departmental offices):
El Transfer ❑ Loan
Asset # Item Description (Make/Model) Serial # Est Rtrn Date
I acknowledge receipt of the above referenced equipment. I will return this equipment
when it is no longer required in the same condition, or better than I received it.
Grantor (from) Grantee (to)
Dept Name: Dept Name:
Custodian: Custodian:
Today's Date: Today's Date: