Fillable University of Hawaii at Hilo - Disposal Application Form

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University of Hawaii at Hilo - Disposal Application Form

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Origination Date: 07/01/99 Revision Date: 04/25/00
FMIS-76 CAMPUS:
UNIVERSITY OF HAWAI‘I
DATE: /
DISPOSAL APPLICATION
(MM/DD/YY)
(See last page for instructions)
PROPERTY CUSTODIAN: TELEPHONE NO.:
DEPARTMENT:
To comply with state laws and regulations regarding disposal of government assets, please complete the following:
1
. Full description of property:
Asset Number Decal
Number
Description Purchase
Price
Acquired
Date
(mm-dd-yy)
Disposal
Code
*
Current
Estimated
Value
Number of items:
Total: $
For
federally-owned property
, provide the following information:
a) Grant and/or contract no.
b) Written agency approval for property disposal should be attached, if required (Refer to APM A8.535 Disposal or Transfer)
* Disposal Code:
The primary reason for disposing of the property.
(List one code per item in Section 1.)
Code Condition
DA
WO
TR
OB
TO
TH
LO
FR
OT
Damaged beyond economic repair
Worn and unserviceable
Trade-in and/or exchange
Obsolete
Transfer out of University
(Attach AGS Form 18 if transferring to another State Agency)
Theft
(Attach Report of Loss or Damage of State Property & Police/Campus Security Report)
Lost/Missing
(Attach Report of Loss or Damage of State Property)
Fire
(Attach Report of Loss or Damage of State Property)
Other (Specify here: )
DISPOSAL APPLICATION NO.
D
0.00
Origination Date: 07/01/99 Revision Date: 04/25/00
2
. Trade-In:
The following offers were received:
Cost Cost
Firm w/o Trade Offer w/Trade
Estimated current market value of property $
3
. Request approval to:
Dispose by destruction Transfer out of University Dispose by sale
Salvage for parts Relief of accountability
Trade-in Other
Application to Dispose
Application is hereby made for the disposal of government property under my custody and control. Pursuant to Chapter 130,
subtitle II, title 3, Hawai‘i Administrative Rules, I do solemnly swear and affirm the accuracy of this application.
Signature of Property Custodian Date
Signature of Fiscal Officer F.O. Code Date
Approval to dispose:
Inventory Management Date
Disposal Certification
I certify that the property involved has been disposed of in the approved manner and that said property has not been directed
or converted to improper use.
Signature Print/Type Name Date
(When disposal certification is completed, return the original to Inventory Management)
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University of Hawaii at Hilo - Disposal Application Form

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Completed 17 April 2020

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