Property Change Notice
*Required Fields

*Date:

*From: (account name and number)

*To: (account name and number/address)


*Change of Accountability
Intra-Dept Transfer Missing Surplus Stolen  

*Change of Location
To Be Moved      Already Moved       Date of Move

*Items contain hazardous materials    Yes     No
*I certify that the hazardous materials have been properly removed    Yes     No

Tag Number
*Description and Serial No.
*From Location
*To Location
Building
Room
Building
Room

*Justification


*Fiscal Agent


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