INVENTORY AND INSPECTION REPORT OF UNSERVICEABLE PROPERTY

As of ____________________________________

_________________________ _____________________________ ________________________ ____________________________

(Agency) (Name of Accountable Officer) (Designation) (Station)

INVENTORY INSPECTION REPORT

No. of Yrs. DISPOSITION
Property Date Accumulated Appraisal Amount
Articles Quantity Unit cost Total Cost in O.R. No.
No. Acquired Depreciation
(1) (2) (3) (4) service (15)
(5) (6) (8) (9) (10) (11) (12) (13) (14) (16)
(7)

I HEREBY request inspection, and disposition I CERTIFY that I have inspected each and every I CERTIFY that I have witnessed the disposition
pursuant to Section 79 of PD 1445, of the property article enumerated in this report and that the disposition of the articles enumerated on this report this _____day
enumerated above. made thereof was, in my judgement, the best for the of ____________________, 20 ________.
public interest.

Requested by: Request for Inspection Approved by:

__________________________________ ___________________________________ __________________________________ ___________________________________

(Signature of Accountable Officer) (Name and Signature) (Name and Signature of Inspector) (Name and Signature of Witness)

__________________________________ ___________________________________
(Designation of Accountable Officer) (Designation)