RETURN TO CSUN HOMEPAGE

 
Surplus Property Request Form (Form 116)
FILL OUT FORM, PRINT 2 COPIES, SUBMIT 1 COPY TO ASSET MGMT (MAIL DROP 8209) & KEEP 1 COPY FOR YOUR RECORDS.
Log Number: _________________
Name of School, Department or Administrative Area Page of
I. PROPERTY INFORMATION: Please complete all sections and include the SERIAL NUMBER:

Description:
Tag #:
Serial Number:
Dispensation Code:
Location:
Survey #:
Survey Date :

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LINK TO ADD ADDITIONAL ITEMS DATE NEEDED BY ITEMS ALREADY MOVED
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II. WHY SHOULD THE UNIVERSITY REMOVE THIS PROPERTY FROM ITS RECORDS? ( Please give adequate details (i.e. attach documentation of repair costs, repairman's written statement of unrepairability, vendors' written trade-in offer, theft report number, etc.)

** Computer Displays, TV Monitors & Laptop Notebooks are considered hazardous materials and departments will be charged for disposal. **
Replacement Requisition Number:  
Name of Contact Person: Phone / Mail Drop:


Signature, School Dean Or Administrative Dept. Head: ___________________________________      Date: ____________

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~ FOR OFFICE USE ONLY ~
RECEIVED
COMPLETED
Asset Mgmt Office
University Postal Services
University Postal Services
Asset Mgmt Office
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