Cooperative Extension Service Off Extension Property Form	MISC-373 3-24-04
Please Return Form to Financial Services
Name
Title
Department Name	Orgn. #
Equipment Information
CES Tag #	Make	Model
Serial Number
Description
Fill in below the reason for Off-Campus/Headquarter Use (Please be as specific as possible)
Location of Off-Campus/Headquarter Use
Address	Apt. #
City	State	Zip
Expected date of return
Signature of Individual in Possession of Property
Date
Signature of Department Head
Date