Revised 10.26.17 No Altered Forms Accepted Original: Capital Assets Accounting (District)
2411 West 14
Street Tempe Az, 85281
To be completed by donor (or donor’s representative) Campus: ____________
Make, Model, Description
___________________ ______________________ _________ _____________________
*Fair Market Value (attach Campus Location Tag Number Serial Number
supporting documentation)
(FMS UnitBuilding Number - Room) (if applicable)
Restrictions on use, if any
______________________________ _______________________________ ________
Printed Name of Donor Signature of Donor Date
______________________________________ ________________________________
Address City, State, Zip
________________________________________________ _______________________
Email Address Phone Number
___________________________ ________________________________ _________
Printed Name of Recipient Authorized Signature of Recipient Date
The following factors have been considered (** Must be completed prior to Authorized Recipient Signature)
(Check off, as applicable)
_____ Maintenance/repair costs ______ Staffing or other hidden costs
_____ Company endorsements are not implied ______ Suitable equipment for program
_____ Replacement will/will not be requested in the future ______ Restrictions on usage are acceptable
_____ District will receive item clear of encumbrances ______ Installation costs
_____ Item has five or more years of usage before replacement
Completed by President, Vice Chancellor or designated administrator and Vice President, Dean,
Department Chair or Designee: The following signatures constitute the recommendation to accept this donation.
__________________________ ________ __________________________ _________
Signature of President, Vice Chancellor Date Signature of Vice President, Dean,
or Designee Dept. Chair or Designee
Completed by District Office Personnel:
Capital Asset Management _______________________________ __________
Signature of Capital Assets Manager Date
Note: Donated property shall become the property of the Maricopa County Community College District and subject to
the same controls and regulations applicable to all other District owned property. Donor relinquishes all rights
affecting ultimate disposition of the property. The tax-exempt status of the District is determined by statutory
definition as a political subdivision of the state pursuant to Section 115 of the Internal Revenue Code. Donations
to any of the Maricopa County Community Colleges fall under the provisions of Section 170 (c) (1) of the Code.
Consideration: No consideration (i.e., goods or services in whole or part) is provided for any property donated to
Maricopa County Community College District
*Value: The value of this gift has been established as fair market value at time of donation. Fair market value
was obtained from vendor price lists or catalogs, by contacting a vendor, or by an independent appraisal.