WEST VIRGINIA STATE DEPARTMENT OF EDUCATION
DISPOSAL FORM - FIXED ASSETS
Person Responsible for Asset
Telephone
Extension
Location and Sub-Location
Asset Description
Reason for disposal (circle one condition below and complete descriptive information as required).
No Longer Needed
Lost
Stolen
Destroyed
Other
Condition of Asset (Good, Fair, Poor, Broken)
Asset Value
Manufacturer
Serial Number
Model Number
Fixed Asset Tag Number (if applicable)
Location and Sub-Location where asset will be housed
If the asset was lost, stolen, or destroyed, the above information should be available by
reviewing the last physical inventory report where the asset was recorded. In the case
where more than one asset is lost, stolen or destroyed please complete a separate disposal
form for each asset.
If the asset is no longer needed, attach the reason why and contact the Office of Internal Operations to
make arrangements for storage of fixed asset until retirement to Surplus Properties.
If the asset was lost or stolen, attach the description of the events leading to this discovery and elaborate
on efforts undertaken to locate the asset (be specific and provide a detailed explanation). Also attach a
copy of a police report (or equivalent).
If asset was destroyed, attach the date of destruction and describe how this occurred and whether or not
the item can be recovered (i.e., flood, hurricane, fire, dropped, etc.) Reports should be filed and attached
as applicable (i.e. insurance, police, etc.).
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Staff Signature
Date
Return this form and any attachments to: Office of Internal Operations, Building 6, Room 204.