HomeMy WebLinkAbout06.a.2.a Asset Dispossal 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 I Vandalized
❑ Damaged ❑ Returned to Vendor
* If Stolen / Vandalized, please provide a copy of the police report.
Asset # Item Description (Make/Model/BV) Serial #
13579 Canon iPF825 and Colortrac SmartLF CI40 (10/1/2012) BV: $0.0 AADH0886
Dept Name: Admin (IT) Requested by: Jonelle Cramer
Dept Head Approval: Date: 10/27/2023
Final Disposal Details
Method of Disposal: Date:
Details/Comments:
Person Disposing: Date:
Witness: Date:
Transfer/Loan Section (Between departmental offices):
❑ 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: Admin (IT) Dept Name:
Custodian: Custodian:
Today's Date: Today's Date:
AGENDA ITEM 5-a.2.a
REQUEST FOR SURPLUS DECLARATION AND/OR
ASSET DISPOSAL AUTHORIZATION
11/07/23
Asset Description Cost Per Unit Acquired Date Book Value
13579 Canon Multifunction scanner/copier 44" $ 8,647.00 9/30/2012 0.00