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RECEIPT FOR PROPERTY by broverya80

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									                                                                                                           Attachment G

                                      RECEIPT FOR PROPERTY
                                   (Administrative Review Purposes Only)
Department:                                     Location:

Name of Person from Whom Property Was Obtained:                             Owner               Other (Specify)




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Address:



Purpose for Which Obtained:

Item #:                                                  Quantity:
Description of Articles (include model, serial #, identifying marks, value, when appropriate):




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I certify that I have received and hold myself responsible for the articles listed above:
Date:                 Typed Name:                                    Signature:


                                           CHAIN OF CUSTODY
Item #:     Date:            Relinquished By:                Received By:               Purpose of Change of Custody:
                      Typed Name:                       Typed Name:

                      Signature:                        Signature:

                      Typed Name:                       Typed Name:

                      Signature:                        Signature:

                      Typed Name:                       Typed Name:
Sa
                      Signature:                        Signature:

                      Typed Name:                       Typed Name:

                      Signature:                        Signature:

                      Typed Name:                       Typed Name:

                      Signature:                        Signature:


                                                            Form for Policy 534-02-DD, Effective 1/30/07, Revised 8/30/07

								
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