Surplus Property Disposition
WV-103 Inventory Form STATE OF WEST VIRGINIA Page of
Rev. 06/01/03
Purchasing Division ---- Surplus Property Unit
Date
SURPLUS PROPERTY RETIREMENT FORM Retirement Number
(For use when retiring equipment with an acquisition cost of $1,000 or less and not on the WVFIMS Fixed Assets System) [To Be Assigned by the Agency]
Department Name
Org #:
Object Code:
Department Address
Division Name and Address
Specific Location of Equipment
Agency Inventory Coordinator
Telephone # ( )
FAX # ( )
Recommended Disposition Method
(CHECK ONLY ONE)
Agency Will Deliver to Property (1)
Request Pickup by Surplus Property (2)
Request Sale on Site (3)
Sell for Scrap Value (4)
Send to Landfill (5)
[Use one disposition method per form]
Submit Completed Form to:
Purchasing Division
Administrative Services Section
Surplus Property Unit
2700 Charles Ave
Dunbar, WV 25064
Inventory
Tag #
No. of Units
Description
Original Acq Cost
Acquisition Date
PO Number
PO Date
Physical Condition, Age, and Estimate Cost of Repairs
Model
Make
Serial Number
The items listed on this form are not part of my agency’s WVFIMS Fixed Asset Inventory
Recommended Disposition Method
Approved
Disapproved
If Disapproved, Preferred Disposition Method
is No. (see above)
Manager of Surplus Property Unit
Date
Agency Authorized Signature
Title
I do hereby certify that I have this day witnessed disposal by the Surplus Property Unit
Agency Signature
Title
Date
This retirement document has been completed by the Surplus Property Unit
Signature
Title
Date
Distribution:
( Agency send original and one (1) copy to the Surplus Property Unit.
( Agency retain copy for their files.
| |
WV-103A Inventory Form- STATE OF WEST VIRGINIA Page of
Continuation Sheet
Rev. 06/01/03 Purchasing Division ---- Surplus Property Unit Retirement Number
SURPLUS PROPERTY RETIREMENT CONTINUATION SHEET
INFORMATION ON THIS FORM MUST BE TYPED OR CLEARLY PRINTED WHEN SUBMITTED TO THE SURPLUS PROPERTY UNIT, PURCHASING DIVISION
|Inventory |No. of |Description |Original Acq |Acquisition Date |PO Number |PO Date |Physical Condition, Age, and |
|Tag # |Units | |Cost | | | |Estimate Cost of Repairs |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |The items listed on this form are not part of my agency’s WVFIMS Fixed Asset Inventory
-----------------------
INFORMATION ON THIS FORM MUST BE TYPED OR CLEARLY PRINTED WHEN SUBMITTED TO THE SURPLUS PROPERTY UNIT, PURCHASING DIVISION
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