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Movable Asset Disposition Form

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