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EOUIPMENT ACCEPTANCE TRANSFER, REASSIGNMENT <br /> 'RELOCATION OR DISPOSAL FORM <br /> RECEIVED <br /> .i~N I~' 9 ~C,~5 Unit No. i54 <br /> Department 43 <br /> DIREGTO,q OF <br /> UTILITIES Transfer Date 01-07-03 <br /> <br /> Year Model Make of Vehicle Description Identification No. <br /> 1990 GMC S-15 1GTCS14R8M8534490 <br /> <br /> License No. Radio Yes Insured Yes Date Purchased Cost <br /> 591-251 XX No No <br /> <br /> Title No. Driver Disposltior and Date <br /> <br /> is transfer, etc., being made? <br /> <br />Have all'available manuals, and operating instructions been furnished to receiving party or <br />available at Garage' " Ye~ .... No. <br /> <br />What use will be made of equipment in receiving department?.: ' ' ' .......... <br /> <br />General condition of equipment [Garage Superintendent) <br /> <br /> Fair <br /> <br />S,gned Original Dept. ~~/~,~~ ' ' Dit,' //~//'~ <br />Si~ned Receiving Dept."-~JL?_~ ~~~ Date].///~/ <br />Signed Garage Dept. Date -- <br /> <br />Signe~ Purchasing AgtJ' Date <br /> <br /> <br />