WASTE MATERIALS REPORT

No. 3
Entity Name:

COURT OF TAX APPEALS

Fund Cluster: 01101101

Property and Supply Division

Place of Storage:

Date: 2/19/2015

ITEMS FOR DISPOSAL

ITEM

QTY.

UNIT

pc.

RECORD OF SALES
Official Receipt
No.
Date
Amount

DESCRIPTION

Omron Relay- 5A 4PTDT 220VAC

***Nothing follows***

TOTAL
Disposal Approved:

Certified Correct:

BABY ROSE C. BELLON

Property Officer

Signature over Printed Name of Head

Agency/Entity or his/her Authorized
Representative

CERTIFICATE OF INSPECTION
I hereby certify that the property enumerated above was disposed of as follows:
Item
Item
Item
Item

Destroyed
Sold at private sale
Sold at public auction
Transferred without cost to ___________

Certified Correct:

Witness to Disposal:

Signature over Printed Name of

Signature over Printed Name of

Inspection Officer

Witness