FIXED ASSET NOTIFICATION FORM
DEPARTMENT _____________________________________________________________________________
THIS NOTIFICATION IS FOR: ADDITION UPDATE TRANSFER DISPOSAL
ACQUISITION IS BY: PURCHASE DONATION LEASE TRANSFER
(ATTACH COPY IF DONATED)
DATE OF TRANSACTION ________________________
ESTIMATED: LIFE EXPECTANCY __________________ MILEAGE OR HOURS _____________________
SERIAL OR VIN NUMBER: ___________________________________________________________________
LOCATION _______________________________________________________________________________
TOTAL/PARTIAL VALUE OF ASSET: _________________________________________________________
(IF DONATED FAIR MARKET VALUE, HOW DETERMINED, AND DATE BOARD APPROVED)
DESCRIPTION: ____________________________________________________________________________
__________________________________________________________________________________________
(BUILDING DESCRIPTION MUST INCLUDE SQUARE FOOTAGE, BUILDING MATERIAL, ROOF TYPE, AND IF EQUIPPED WITH SPRINKLER SYSTEM)
.........................................................................................................................................................
BRAND OR MAKE: _______________________ MODEL NO. _____________________________________
YEAR: __________________________________ LICENSE NO. ____________________________________
GROSS VEHICLE WEIGHT: ________________
(TRUCKS ONLY)
IF DISPOSED-METHOD: SOLD $ _________ TRADED JUNKED SCRAPPED
STOLEN/WRECKED
END-OF-LEASE TRANSFERRED TO: ______________________________________________________
PERSON RESPONSIBLE: __________________________________________________________________ SIGNATURE
__________________________________________________________________
PRINTED NAME
DEPARTMENT HEAD SIGNATURE: __________________________________________________________
IF TRANSFERRED,
RECEIVING PERSON'S SIGNATURE: _________________________________________________________
_________________________________________________________
PRINTED NAME
................................................................................................................................................ ..........
CLERK-TREASURER'S USE ONLY
RECEIVED: ____________________________ ENTERED FIXED ASSET: ___________________________
INSURED: ______________________________ CLERK-TREASURER'S INITIAL: ______________________
(Ord. 2002-13, passed 10-21-02)