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INDIAN RIVER COUNTY <br />FORM FOR DISPOSAL/TRANSFER OF EXCESS PROPERTY 40 <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 Trade-in X Non -Capital Missing/Stolen <br />Asset Number 22047 Department: Public Works/Traffic Eng. Fleet Number: <br />Serial Number: 4038261418 <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 functional/WORKING CONDITION and could be used by another department? <br />It 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 />Yes No X <br />Contact Person: Donte' Tavlor Telephone Number: 772-226-1719 <br />Physical Location of asset: Donte'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 replaced, please answer the following: <br />Purchase Orde mber for Replacement: Req. 41125 <br />Approval <br />set Custodian <br />Approva ` <br />isor/Man er <br />Approval <br />Director <br />If asset transfer, approval of denartmeru receiving asset: <br />Approval <br />Director <br />Additional Comments: <br />Date Replacement `Received N/A <br />I� I�ItY <br />Date <br />01/07 <br />ao/L <br />Date <br />/ X11 <br />/1-6 <br />Date <br />Date <br />To be completed by Budget Department: <br />Approved for: Surpl T Trade-in Replacement <br />Budget I3 <br />Director Date <br />IT IS THE DISPOSING ,EP _ TA4_ENT'S RESPONSIBILITY�T.O KEEP THE-ITEM,UNTIU FACILITIES MANAGEMENT • CAN PICKUP. <br />DO NOT REM _ PROPERTY FROM 1'OUR:L.00ATION' WIT-HOtM P.ROPER,AUTHORIZATION'FOR DISPOSALi ' ~ <br />This 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 />174 <br />