MISC-376 2/25/2020
CERTIFICATE OF MISSING/LOST, STOLEN, CANNIBALIZED/DISCARDED, OR DESTROYED PROPERTY
(**ALL SIGNATURES LISTED BELOW ARE REQUIRED FOR PROCESSING)
County/Department	County/Dept. Manager Signature	Dept. or Unit Head/Associate Director/Dist. Director Signature
Org #	Date	Date
In accordance with the provision of the University of Arkansas – Cooperative Extension Service policy CESP 10-9: Maintaining Equipment - Inventory, I am requesting removal of the following listed property items from the records of this county/department. The items are (check below):
1.	Missing/Lost	(Explain in the Remarks section)
2.	Cannibalized/Discarded	(Explain in the Remarks section)
3.	Stolen	(Attach copy of the Official Police Report)
4.	Destroyed	(Explain in the Remarks section)
CES Tag #:	Description:	Located:	Equipment Assigned to:
REMARKS: (Required for Missing/Lost & Cannibalized/Discarded)
Any lost/stolen computer must be reported to IT immediately. Send a copy of this form to IT.
Please forward original to Financial Services and retain a copy for your records.
FOR FINANCIAL SERVICES USE ONLY:	REQUESTED PERMISSION TO DELETE:
AVP Ext. Date	DfNa Date
PROPERTY ACCOUNTANT SIGNATURE
(UPON REMOVAL FROM INVENTAORY	RECEIVED PERMISSION TO DELETE
Date	AVP Ext. Date	DfNa Date