Property Control Form No.3
Revised June 2014
AUTHORITY TO RELEASE EQUIPMENT FOR REPAIRS
Department Name:
Tag Number: Description:
Picked up for Repairs by:
Maintenance Department
Company Authorized to Repair Said Item
Other (please state)
Authorized By:
Department Head: _________________________________________________
Date: ____________________________________________________________
Picked Up By:
Person’s Name/Company: __________________________________________
Date: __________________________________________________________
Received After Repairs By:
Person’s Name: _________________________________________________
Date: _________________________________________________________
NOTE: PLEASE FORWARD A COPY OF THIS FORM TO THE
PROPERTY CONTROL OFFICE.
This form will assist Responsible Person in tracking equipment
sent for repairs.
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