CUSTODY RECEIPT – PROPERTY REMOVAL PASS

     


    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

     

    Back to top