Description of Property

Model No.

Serial No.

LA State Tag No.

Location: Campus

Building

Room No.

Property Assigned To:

Division

Department / Office

The above equipment is being released on a temporary basis for the following reason:

Use by Another Department/Office

Equipment Repair

Off-campus Activity/Assignment

*Use by Another Agency

(*Approval of Delgado Property Manager must be obtained prior to release of property to another Agency.)

Other

RECEIVED

Printed Name

Signature

Date

RELEASED AUTHORIZED

Printed Name

Signature

Date

EQUIPMENT RETURNED

Printed Name

Signature

Date

Form 1352/001 (8/12)

Original – Retained by Property Control Office

Copy – Person Borrowing Equipment

Copy – Suspense Copy Retained by Property Location

Supervisor