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INDIAN RIVER COUNTY FORM FOR DISPOSAL/TRANSFER OF EXCESS PROPERTY TO: Raeanne Cone, Finance Department DATE: January 4, 2016 SUBJECT: Disposal/Transfer of Excess Property FROM: Ms. Maya Miller Check One: Surplus Transfer Asset Number: 22904 Serial Number: 5061729-418 Trade -In X Non -Capital Department: Public Works/Traffic Eng. Fleet Number: Description: NC -97 Traffic Counters Do you have possession of the asset? Yes X No Missing/Stolen If Lost/Missing has a police report been filed? Yes N/A No If yes, please attach a copy of the police report. If no, state reason: N/A Is the item functionaUWORKING CONDITION and could be used by another department? Yes No X If not in working condition, description of problems with item. Counters no longer compatible w/new software and do not function If transfer, department transferred to: N/A Contact Person: Donte' Taylor Telephone Number: 772-226-1719 Physical Location of asset: Donte's office or Traffic Engineering file room. (The above information will aid Purchasing and Facilities Management in the process of equipment removal from department). If asset will be replaced, please answer the following: Purchase Ordmber for Replacement: Req. # 1125 Approval C t Custodian Date Replacement Received N/A 1- r7 rrLP Date I Approv Supe isor ger Dat Approval ( Director Date If asset transfer, approval of department receiving asset . Approval Director Date Additional Comments: To be completed by Budget Department: Approved for: Su rp s Trans Trade -In Replacement Budget W Director Date IT IS THE DISPOSIN DE RTMENT'S RESPONSIBILITY TO KEEP THE -ITEM UNTIL FACILITIES MANAGEMENT CM PICK UP. I)U NOT REy _ E PROPER7l' FROM'l'OU12 LOCATION WITHOUT PROPER AUTHORIZATION. FOR DISPOSAL This form is to be used for all property with or without an asset number assigned. Please attach a copy of this form securely to the item being disposed of All other forms for disposal/transfer of property now obsolete. Revised: August 2015 172