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INDIAN RIVER COUNTY <br />FORM FOR DISPOSAL/TRANSFER OF EXCESS PROPERTY • <br />TO: <br />Raeanne Cone, Finance Department <br />DATE: <br />Januar 4, 2016 <br />SUBJECT: <br />DisposaUTransfer of Excess Property <br />FROM: <br />Ms. Maya Miller <br />Check One: Surplus Transfer Trade -In X Non -Capital Missing/Stolen <br />Asset Number: 22906 Department: Public Works/Traffic Eng. Fleet Number: <br />Serial Number: 5061711418 <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? 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 replaced, please answer the following: <br />Purchase Ord"umber for Replacement: Req. # 1 125 <br />Approval <br />t Custodian <br />Approval iJ <br />aupery anger <br />Approval <br />Director <br />If asset transfer, approval of department receiving asses <br />Approval <br />Date Replacement Received N/A <br />Date <br />Oi A7 /.10/� <br />Date <br />/////16 <br />Daet <br />Director <br />Date <br />Additional Comments: <br />To be completed by Budget Department: <br />Approved for: SurplusTransfer , Trade -In Replacement <br />Budget 6 <br />Director Date <br />1T IS THE DISPOSING DE — ENT'1 "i t' ONSIBILITY TO KEEP THE,ITEM.UNTIL FACILITIES MANdGEMENT'CAN PICK UP. <br />DO NOT REMO _ OPERTY'FROM-YOIJR LOCATION Vl'TTNOIIT PROPER AUTHORI_ZATIQN FOR DS$OSAL <br />This form is to he 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 />175 <br />