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Rensselaer Polytechnic Institute Office of Property Administration - Modular 01 Bldg. |
| Requestor Name | Date |
| Department | Telephone No. |
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List the requested ACTION(S) in Section I using the codes listed below; Sign in Section II, as applicable.
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T1
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TRANSFER - to another department |
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T2
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TRANSFER - to temporary storage (Chasen Building/Stone Warehouse) |
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L2
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LOCATION CHANGE - to another on-site location |
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L3
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LOCATION CHANGE - to an off-site location (at home) |
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D1
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TRADE IN - toward purchase of new equipment |
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D2
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OBSOLETE equipment; will be discarded or cannibalized for parts. |
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D3
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NON-REPAIRABLE equipment; discard or cannibalize for parts |
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D4
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LOST or STOLEN equipment; will will not be replaced (Attach copy of Public Safety Report to this form) |
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D5
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Other (explain) |
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SECTION I: EQUIPMENT INFORMATION
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Action
Code |
RPI Tag No.
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Description
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New Dept / Location
(List Bldg, Room No. Address, as appropriate) |
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SECTION II: APPROVAL SIGNATURES
I (WE) CERTIFY THAT THE LOCATION CHANGE AND/OR DISPOSITION CONSTITUTES INSTITUTE BUSINESS AND WILL ASSUME RESPONSIBILITY FOR THE EQUIPMENT LISTED.
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Approved by:
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Typed/Printed Name
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Signature and Date
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| Originating Dept. Chair/Director | ||
| Receiving Dept. Chair/Director | ||
| Contracts and Grants | ||
| Office of Property Administration |
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For Office of Property Administration Use Only
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| Record changed by: | Date: |
| File Reference/Notes: | |