The University of Michigan
SOLD Declaration of Surplus #
Office of Property Disposition
On-Site Declaration of Surplus Form
P.D Warehouse Phone:(734)764-2470 Fax:(734)763-2006 Shortcode (Required)
Date:
1. Requirements
A. Please call Property Disposition at (734) 764-2470 to set up the time/date for delivering your items out to the warehouse. B. This form must be typed to insure legibility.
C. You must provide your department Shortcode*** D. When sending computers, see #4 below.
2. Contact Information: 3. Chartcom Information:
Contact Person: *** Shortcode: Program:
Department Name: Fund: Class:
Address: Dept ID: Project Grant:
Phone: Dept Fax:
4. For Computers Only:
If computers or storage media are being declared as surplus, the following statement must be clearly signed in accordance with SPG 520.1
I certify that all surplus computers and storage media declared on this form have been sanitized
(Please Print Name) (Signature) (all applications and data removed) in accordance with SPG 520.1
Yrs./ Estimated For Computers Only
Specific Description Qty Category Description U of M Tag # Serial # Condition Age Months Original Cost Value RAM Hard Drive Speed
1
2
3
4
5
6
7
8
9
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Yrs./ Estimated For Computers Only
Specific Description Qty Category Description U of M Tag # Serial # Condition Age Months Original Cost Value RAM Hard Drive Speed
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
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Yrs./ Estimated For Computers Only
Specific Description Qty Category Description U of M Tag # Serial # Condition Age Months Original Cost Value RAM Hard Drive Speed
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
57e89df0-a308-43a7-8ebe-10058782518c.xls Page 3 of 3 2/26/2009