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Departmental Equipment Change Report


Name or Description of Item
R.U. Property Tag number
Item Serial Number
Manufacturer

EQUIPMENT TRANSFER

Previous Location
Department
Building
 Room
Current Location
(Where equipment was transferred to)
Date of transfer
Department
Building
Room
   

Other

(Select either Trade-In, Warranty Replacement, Stolen or Lost)
Trade-In Equipment for Purchase of New Equipment List the P.O. Number
referencing trade-in
  Asset tag # of trade-in
  Serial # of trade-in
  Date trade-in surrendered to vendor
Warranty Replacement Asset tag # of equipment being replaced
  Date surrendered to vendor
  Asset tag # of replacement equipment
  Serial # of replacement equipment
  Date the replacement was received
Stolen Last Known Location
  Date stolen
  Police Department and Police Report Number
Lost Last Know Location
  Date item was identified as lost
Comments
Prepared by Date

Please print before sumitting report.