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                                                                                   INVENTORY CONTROL
                          "RECORD OF PROPERTY TRANSFERRED FROM OTHER ORGANIZATIONS" - IC-4

MAIL ENTIRE PACKAGE TO:      Inventory Control,  Building J,   MC 6170                                                Phone:   679-1952  
TRANSFERRED TO:

NAME:     
    
DEPARTMENT:
MAIL CODE:  MC         E-MAIL: 
DESCRIPTION OR ITEM: 
                                                                             (Include Identifying Serial Number, Make, Model, Size, Color, etc.)
ORGANIZATION MAKING TRANSFER:
Contact Person:
Address:            
                     
                     
Phone:                
DATE RECEIVED: 
ORIGINAL ACQUISITION COST:    ORIG. ACQUISITION DATE: 

If the original acquisition cost is not available, please provide the fair market value: 

ESTIMATED LIFE:      PERMANENT LOCATION: 
CONDITIONS OF TRANSFER: ( If Any) 
    
    
    

SIGNATURES:

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Department Head                                                                                            Date

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Dean                                                                                                               Date

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Inventory Control                                                                                        Date