Declaration of Surplus Property

2. Date*
   Date

3. First Name*

4. Last Name*

6. Department*

7. Department Number*

9. Physical Location of Property*

11. Reason for Disposition*

    1. Item(s) no longer required
    2. Lost or stolen (attach explanation) †

    † Any property reported as lost or stolen with an original cost exceeding $5,000 requires the written justification for removal from inventory must be attached to this form, signed by the Department Head.

13. Attachments

    Upload any attachments, such as justification for lost or stolen items.

15. Has all sensitive City data been totally erased?*

    Any computer hardware, cell phone device, or other storage medium used to hold City data must be totally erased or rendered unreadable before it is disposed of through departmental transfer or surplus property. Employees should contact the IT Division for assistance if necessary.

    1. Yes
    2. No

    1. Hard Drive Removed
    2. Memory Removed

    1. Not Applicable
19. List of Items*

    Include Quantity, Description of Property, Year of Purchase (if available), City Equipment ID (if available), Condition of Property, and Estimated Current Value.

23. Method of Disposal

    1. Auction
    2. Storage for future use
    3. Sell as scrap
    4. Landfill

24. Date of Disposal
    Date of Disposal

Leave This Blank:


26. Submit

* indicates a required field