Rochester EOC Property Removal Request

Removal Information
Authorization is valid from the removal date listed. Authorization is only valid for 14 days from the removal date. Any extensions need to be authorized by the applicable department head and Rochester EOC Technology Services.

Name Name First Last
Department
Email
Supervisor's Email

Please add your supervisor's email for their reference.
Justification of Removal
Item(s) Removed (including Serial #, Item, Asset/Decal#, Manufacturer, Model, Quantity and Condition
Destination/Location where property will be moved:
Item(s) Requested
Date Date / MM / DD YYYY
Signature
I understand that my printed name is given as the legal representation of my signature.