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r <br />INDIAN RIVER COUNTY <br />FORM FOR DISPOSAL/TRANSFER OF EXCESS PROPERTY <br />TO: <br />Raeanne Cone, Finance Department <br />DATE: <br />January 4, 2016 <br />SUBJECT: <br />Disposal/Transfer of Excess Property <br />FROM: <br />Ms. Maya Miller <br />Check One: Surplus Transfer <br />Asset Number: 22552 <br />Serial Number: 5021047-418 <br />Trade -In X Non -Capital <br />Department: Public Works/Traffic Eng. Fleet Number: <br />Description: NC -97 Traffic Counters <br />Do you have possession of the asset? Yes X No <br />If Lost/Missing has a police report been filed? Yes N/A No <br />If yes, please attach a copy of the police report. If no, state reason. N/A <br />Is the item funclionaUWORKING CONDITIOA' and could be used by another department? <br />Missing/Stolen <br />Yes No X <br />If not in working condition, description of problems with item: Counters no longer compatible w/new software and do not function <br />If transfer, department transferred to: N/A <br />Contact Person: Donte' Taylor Telephone Number: 772-226-1719 <br />Physical Location of asset: Dome's office or Traffic Engineering file room. <br />(The above information will aid Purchasing and Facilities Management in the process of equipment removal from department). <br />If asset will be re laced, please answer the following: <br />Purchase Orde bei for.Replacemeni: Req. # 1125 <br />Approval MAI'— — <br />Ass Custodian <br />Approval <br />5Supe or/Manag <br />Approval <br />Director <br />If asset transfer, approval of department receiving asset: <br />Approval <br />Director <br />Additional Comments: <br />To be completed by Budget Department: <br />Approved for: S Wflu Tranl ,/ <br />Date Replacement Received N/A <br />1I - �' - ((v <br />Date <br />In Replacement <br />Budget <br />Director Date <br />IT 1&THE 1)ISPOS09F ARTMENT'S,RESRONSIB1Ll-T%' TO NEEP THE'ITEM UNTIL FACILITIES MANAGEMENT CAN* <br />PIGK UP_. <br />�:r __ . <br />DO NOT'PROPERTY FROM l.66R LOCATION WITH. Lir P.ROPER'AUTHORIZ:4TION.FORhis form is to be used for all property with or without an asset number assigned. <br />Please attach a copy of this form securely to the item being disposed of <br />All other forms for disposal/transfer of property now obsolete. <br />Revised: August 2015 <br />D1/oi/aot(. <br />Date <br />/ /i/ 41e; <br />Date <br />Date <br />173 <br />