Revised Form: 4/2013

PROPERTY DISPOSAL REQUEST – COMPUTER & ELECTRONIC ITEMS – PP4-C SURPLUS PROPERTY 2045 Westland Road, Cheyenne, WY 82002 Office: 307-777-7901 Fax: 307-634-5710 Agency Name and Address: _____________________________________ Agency Rep Name: ____________________________________________ Agency Rep Phone #: __________________________________________ Line Item

State Asset Tag #

Division Name

Description

Serial Number

Wolf’s FD Document Number

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Agency Rep Signature: __________________________________Date: _________________ ***Original copy to Surplus*** - Agency File Copy – State Inventory Rep Copy to Woodson Bldg. c/o [email protected] 307-777-5088

Line State Asset Item Tag #

Division Name

Description

Serial Number

Wolf’s FD Document Number

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 PROPERTY DISPOSAL REQUEST – COMPUTER AND ELECTRONIC ITEMS – Page -2Agency Name: ____________________________________________ Agency Rep Name: ________________________________________ Agency Phone Number: ____________________________________ ***Original Copy to Surplus*** - Agency File CopyState Inventory Rep Copy to Woodson Bldg. c/o [email protected] 307-777-5088