Asset Disposition Form

  Date:                                   

  Requested By:                                             

  Department:                                                

  Reasons for Disposition:                                                                                            
                                                                                                                              


                                                               Expected or
                              Serial Date      Original      Net Book      Actual        Gain or
             Description       Number            Purchased        Cost  Value      Proceeds     Loss 











































  Department Manager:                           Date:                         

  Chief Financial Officer:                      Date: