APPENDIX A: FIXED ASSET NOTIFICATION FORM
DEPARTMENT: ___________________________
THIS NOTIFICATION IS FOR:   ADDITION      UPDATE      TRANSFER      DISPOSAL
ACQUISITION IS BY:      PURCHASE    DONATION    LEASE         TRANSFER
   (ATTACH COPY)
DATE OF TRANSACTION: ________________________________________
ACCOUNT NO. _______________ P. O. NO. __________________
ESTIMATED: LIFE EXPECTANCY _________ MILEAGE OR HOURS ________
CIP NUMBER: __________________ LOCATION: ___________________
SERIAL OR VIN NUMBER: ________________________________________
TOTAL/PARTIAL VALUE OF ASSET: _______________________________________
(PLEASE ATTACH OR FORWARD COPY OF CHECK(S) TO DOCUMENT COST.
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 OR BOILER.)
BRAND OR MAKE: _______________      MODEL NO.: _________________
YEAR: _______________________          LICENSE NO.: ________________
                                       ATTACH COPY OF REGISTRATION
GROSS VEHICLE WEIGHT: ___________            TYPE OF FUEL: __________________
                  TRUCKS ONLY
IF DISPOSED-METHOD:         SOLD $________ TRADED         JUNKED   SCRAPPED
STOLEN/WRECKED            END-OF-LEASE      TRANSFERRED TO: _____________
(ATTACH POLICE REPORT)
DATE BOARD APPROVED: ___________            DATE COUNCIL APPROVED: _______
(ATTACH COPY OF MINUTES)                  (REAL PROPERTY VALUE> $9,999)
DATE MAYOR APPROVED: ___________ SIGNATURE: _____________________________________
      (REAL PROPERTY ONLY)
PERSON RESPONSIBLE: ___________________         ______________________________
                  SIGNATURE                  PRINTED NAME
RESPONSIBLE DEPARTMENT HEAD'S SIGNATURE: ________________________
IF TRANSFERRED
RECEIVING PERSON'S SIGNATURE: ___________________________________
            PRINTED NAME: _________________________________
CLERK-TREASURER'S USE ONLY
RECEIVED: ______________________         ENTERED FIXED ASSET: ___________
INSURED: _______________________         CLERK-TREASURER'S INITIAL: _______