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					                         ARKANSAS DEPARTMENT OF FINANCE AND ADMINISTRATION
                                OFFICE OF INTERGOVERNMENTAL SERVICES
                               VICTIM JUSTICE AND ASSISTANCE PROGRAM

                                 PROPERTY EQUIPMENT DISPOSAL FORM

                                                 Subgrant #:

                                                 Grant Period:         to

Subgrant Organization:

Street Address:

City:                         State:                             Zip Code:


Description of Property/Equipment for Disposal




Date Purchased                Purchase Price



Reason for Disposal




Manner of Disposition




Name and Title of Authorized Offical



Signature Authorized Official                                          Date




REVISED: DECEMBER 2009

				
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posted:9/21/2011
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