Equipment Transaction Record

Equipment Transaction Form
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STEP 1: EQUIPMENT IDENTIFICATION

Decal #	Current Location		Description (Include Model, Serial Numbers, Color, Etc.)	Operable?	New Location
Decal #	Bldg	Room	Description (Include Model, Serial Numbers, Color, Etc.)	Operable?	Bldg	Room
				Yes No
				Yes No
				Yes No
				Yes No
Contact Person Phone

STEP 2: EQUIPMENT TRANSACTION (Check and complete ONLY ONE SECTION for the above items.)

A. EQUIPMENT TRANSFERS BETWEEN DEPARTMENTS

Transferred from Organization	Transferred to Organization
Name of Signing Official	Name of Signing Official
__________________________________________	__________________________________________
Authorized Signature Date	Authorized Signature Date
Custody & responsibility of the above item(s) is hereby reliquinshed (see distribution below).	Custody & responsibility of the above item(s) is hereby accepted (see distribution below).

B. EQUIPMENT TRANSFERS TO SURPLUS (Enter Physical Plant Work Order for Central Receiving to pick up and sign form)

Transferred from Organization	Transferred to Org 860000 Location 112218
Name of Signing Official	Name of Signing Official
__________________________________________	__________________________________________
Authorized Signature Date	Authorized Signature Date
Custody & responsibility of the above item(s) is hereby reliquinshed (see distribution below).	Custody & responsibility of the above item(s) is hereby accepted (see distribution below).

C. NOTICE OF CANNIBALIZATION OR ON-SITE DISPOSAL (Send form & decals to Accounting)

Department Requesting Cannibalization/Disposal: Organization
Name of Signing Official	Name of Signing Official
______________________________________	______________________________________
Authorized Signature Date	Next Level of Authority Date

D. DECLARATION OF EQUIPMENT AS ZERO VALUE (Keep the decal on the equipment, but mark “ZV” on the decal with a permanent marker)

Department Requesting Zero Value: Organization
Name of Signing Official
______________________________________	Approval Granted:	______________________________________
Authorized Signature Date		Manager of Financial Reporting Date

DISTRIBUTION: ALL departments' signatures must be obtained prior to distribution as follows:
Copy to Property Accountant, Relinquishing Department, and Accepting Department.