Request for Temporary Removal of State Movable Property
Faculty and Sta
Budget Unit Department Title: ________________________________________________________________________
LPAA Account Index: ___________________________________________________________ Date:________________
Instructions:
Fill out the necessary information below and acquire the necessary signatures. You will be notied
if you are requesting to remove equipment that is not under your departmental control. This form
should be forwarded to Property Control for review and approval. Once approved, a copy will be
forwarded to you.
Purpose of o-campus use: ___________________________________________________________________________
Dates equipment is to be used: From: _________________________ To: ________________________
O Campus Location of Property: ____________________________________________________
____________________________________________________
Item Description Tag No. Serial No. Value
I request that I be allowed to remove state movable property from its current operation location. I understand that I
shall be responsible for the equipment while in my care. I also certify that said property will be utilized for university
related business ONLY. The University will enforce LAC 34:VII.305E, which states that each person to whom prop-
erty is entrusted shall be liable for the payment of damages or replacement cost whenever his/her wrongful or
grossly negligent act or omission causes any loss, theft, disappearance, damage to or destruction of property.
By signing this form the Employee also authorizes the University to withhold payment from his/her paycheck
to cover any equipment damage or replacement costs that may occur.
___________________________________________________________________ ______________________
Employee – Print Name CWID
___________________________________________________________________ ______________________
Employee’s Signature Date
___________________________________________________________________ ______________________
Appropriate Vice President’s Signature Date
___________________________________________________________________ ______________________
Department Property Custodian’s Signature Date
___________________________________________________________________ ______________________
Property Control Manager’s Signature Date
Rev. 1/17
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