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SOU T118h <br />City of South Bend <br />,- Request for Asset Disposal <br />lt365 <br />Fixed Asset Disposal Procedure Statement <br />All city departments are required to submit asset disposal requests to the Board of Public Works for approval prior <br />to disposal of an asset. Asset disposal requests must include the following information: <br />Asset description <br />Asset identification number <br />Year of acquisition <br />Historical acquisition value <br />Net book value <br />Reason for disposal <br />Method of disposal (offer for sale, scrap, etc.) <br />The asset disposal request must be signed by the Controller before submittal to the Board of Public Works. <br />Asset # - Improvement # W3441914-0000 <br />Description METERS -- 400 -1" METERS <br />Serial Number <br />Tag/Reference Number E00100 THRU E00399 <br />Asset Type 334 METERS & METER INSTALLS <br />Acquisition Date 01/22/2002 <br />Purchase Cost $ 3,404.24 <br />(hisforlcal acquisition value) <br />Not Book Value $ 2,279.70 <br />(purchase p6ce minus depreciation) <br />Current Location Code WVARUS - WW - VARIOUS <br />Reason for Disposal: Partial asset disposal. Disposing of 216 water meters out of 400. Original asset value $13,981,70. <br />Method of Disposal: <br />Approvals <br />Name <br />Signature Y JDate <br />Department Head <br />�'J� G �/ <br />//� <br />._11— 11 <br />Controller <br />Jennifer Hockenhull <br />( (7a ( Ay <br />Fixed Asset Form 1-B Request for Asset Disposal 1 of 2 <br />