Department Building Room #
Date State ID# Manufacturer
Description Serial #
Acquisition Cost Date Acquired
Particulars of Stolen/Missing Equipment (who, when, where, how)
Method of Custody/Security employed
Date
Action Recommended to Preclude Future Loss/Theft
I certify that this report is a true and complete report of all facts known to me relating to this matter.
I have reviewed this report and have satisfied myself that the report is true and complete. Also appropriate
action will be taken to preclude future loss or theft.
REPORT OF STOLEN/MISSING EQUIPMENT
Central Carolina Technical College
Dean
Vice President
Signature of Department Head
Date
Item was last used by
CCTC Inventory Form 6
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