STOLEN PROPERTY REPORT

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					                              Florida Department of Agriculture and Consumer Services
                                         Bureau of Finance and Accounting

                                           STOLEN PROPERTY REPORT

CHARLES H. BRONSON
   COMMISSIONER


Note: All requested information must be completed:

                                                              AQ DATE
Property ID#                                                  AQ COST
                                                              NETBOOK VALUE
Description

Serial#

1. When was the last date the missing item was used or observed?

2. When was the item discovered missing?

3. What are the circumstances that caused the theft of this item?




4. What steps were taken to make sure the item was secure before it was discovered stolen?




5. What steps have been taken to recover the item?




6. What steps have been taken to prevent a similar theft from happening again?




7. Is a legible copy of the police/sheriff report attached?   YES     NO



DACS-01098 Rev. 05/05
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PLEASE NOTE: TWO SIGNATURES ARE REQUIRED; BOTH THE EMPLOYEE AND
             SUPERVISOR MUST SIGN.

Employee Signature:
Name:                                        Title:

Date:

 ***********************************************************

Supervisory Review:                            Date:

Was this theft caused by negligence?   YES        NO

Comments:




Supervisor Signature
Name:                                        Title:

 ***********************************************************

Finance & Accounting Property Office Review:                 Date:

Comments:




Property Analyst Signature
Name:                                        Title:



                                                Please return this form to:
                                                Property Office
                                                407 S. Calhoun St., Room 109H, M-5
                                                Tallahassee, FL 32399-0800


DACS-01098 Rev. 05/05
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