Form Center

2. Property Tag Number:*
3. Equipment Number:*
4. Date:*
   Date:
5. Unit #:*
7. Year:*
8. Make:*
9. Color:*
10. Odometer/Hour Meter:*
12. Vehicle Description:
13. VIN/serial number:*
14. License Number:*
16. Owning Department:*
17. Using Department:*
19. Type of Disposition:*

    1. Pilferage (Must include Police Report)
    2. To Auction Lot
    3. Trade-In
    4. Donated (Must have Council approval)
    5. Scrapped
23. Condition of Equipment:
25. Paint:
26. Battery:
27. Engine:
28. Differential:
30. Body:
31. Brakes:
32. Steering
33. Transmission:
35. Radio:
36. Clutch:
37. Upholstery:
38. Air conditioner:
40. Glass:
41. Heater:
42. Radiator:
43. Tires:*

    1. RF
    2. RR
    3. LF
    4. LR
45. List all missing engine parts and accessories:
49. I certify that the above information is accurate and this vehicle is free of trash/debris.
51. Authorized Dept./Division Signature*
52. Date:*
    Date:
54. Authorized Fleet Management Signature*
55. Date:*
    Date:
57. Fuel Card
58. Canceled on:
    Canceled on:
59. Fuel Card
60. Canceled on:
    Canceled on:
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field