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y0 Tit <br />p4 kthl+l.11r Yt <br />v� 'n City of South Bend <br />Request for Asset Disposal <br />Ia65 <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 to disposal of an asset. Asset disposal requests must Include the following information: <br />Asset Number Puchase Cost (Historical Aoqutsi8nn Value) <br />Asset Improvement Number (if applicable) Net Book Value (purchase price minus accumulated depreciation) <br />Asset Description Reason fur Disposal <br />Acquisition Date Method of Disposal <br />The asset disposal request must be signed by the Controller before submittal to the Board of Public Works. <br />Asset #- <br />Emprovement# <br />Description <br />Acquisition <br />bate <br />Purchase Cost <br />(hfclodcerecqulsftlon <br />value) <br />Net Book Value <br />(purchaceprrceminus <br />deprecrallonJ <br />Reason for Disposal <br />Method of Disposal <br />20110120-0000 <br />DELL OPTLPLEX 380 DESKTOP COMPUTERS -IT BUDGET <br />04112/2011 <br />$ 640.76 <br />$ - <br />Computer replaced In 2015 <br />Disposed <br />20110356-0000 <br />RICOH COPIER MP2651SP <br />1/312412011 <br />2,569.53 <br />- <br />Copier traded in for new copier <br />Trade-in <br />Total Net Book Value $ <br />Approvals <br />Name <br />f lure <br />Date <br />Department Head <br />Laura O'Sullivan <br />lid <br />Controller <br />Jennifer Hockenhull <br />, <br />\.J 1 � . <br />Fixed Asset Form 1-E Request for Multiple Asset Disposals 1 of 1 Form last updated 12-28-15 <br />