WPC  77WPC >?wAa?y@$ ?O< ?Oo?LN?2 =$ <$/^oSZ7>z  (  Standard'3,, , ,   UB ) 3    *    d +    d ,    d /0gjklmnopqrstuvwxyz{|}~P* * c:\inf42\forms\ad112.wpf c:\inf41\forms\ad112.wpfUS&& &&   >e?f eh Terminal 1 ! d !  d      Terminal eb Arial " ! 2     d    Arial ?Ad A{?z jV c:\1resch\1test\ AD112.DBFHistory   i'Report  #   h REPORT# i%Date     h DATE i$C_1      h C_1  i$C_2      h C_2  i$C_3      h C_3  i$C_4      h C_4  i$C_5      h C_5  i$C_6      h C_6  i$C_7      h C_7  i(StaProp     h STAPROP i%Adr1  ;   h ADR1; i%Adr2  ;   h ADR2; i%Adr3  ;   h ADR3; i%Adr4  ;   h ADR4; i(T_1[A1]     h T_1_A1_ i(T_1[B1]      h T_1_B1_  i(T_1[C1]     h T_1_C1_ i(T_1[D1]      h T_1_D1_  i(T_1[A2]     h T_1_A2_ i(T_1[B2]      h T_1_B2_  i(T_1[C2]     h T_1_C2_ i(T_1[D2]      h T_1_D2_  i(T_1[A3]     h T_1_A3_ i(T_1[B3]      h T_1_B3_   i(T_1[C3]     h T_1_C3_  i(T_1[D3]      h T_1_D3_   i(T_1[A4]     h T_1_A4_  i(T_1[B4]      h T_1_B4_   i(T_1[C4]     h T_1_C4_ i(T_1[D4]      h T_1_D4_  i(T_1[A5]     h T_1_A5_ i(T_1[B5]      h T_1_B5_  i(T_1[C5] !    h T_1_C5_ i(T_1[D5]  "    h T_1_D5_  i(CusName # -   h CUSNAME- i(CusDate $    h CUSDATE i)AcctName % -   h ACCTNAME- i)AcctDate &    h ACCTDATE i$C_8  '    h C_8  i$C_9  (    h C_9  i%C_10  )    h C_10  i(OfcName * D   h OFCNAMED i(OfcDate +    h OFCDATE i%C_11  ,    h C_11  i%C_12  -    h C_12  i%C_13  .    h C_13  i%C_14  /    h C_14  i%C_15  0    h C_15  i(MgrSign 1 D   h MGRSIGND i(MrgDate 2    h MRGDATE i)PropSign 3 D   h PROPSIGND i)PropDate 4    h PROPDATE i)WitnSign 5 D   h WITNSIGND i)WitnDate 6    h WITNDATE i(PropMrg  7    h PROPMRG  i(MgOfcDt 8    h MGOFCDT i*FiscalOfc 9 j   h FISCALOFCj i)FiscalDt :    h FISCALDT : ' REPORT Character #   DATE Date  " C_1 Logical   " C_2 Logical   " C_3 Logical   " C_4 Logical   " C_5 Logical   " C_6 Logical   " C_7 Logical   ( STAPROP Character  % ADR1 Character ; % ADR2 Character ; % ADR3 Character ; % ADR4 Character ; ( T_1_A1_ Character  # T_1_B1_ Memo    & T_1_C1_ Numeric  # T_1_D1_ Memo    ( T_1_A2_ Character  # T_1_B2_ Memo    & T_1_C2_ Numeric  # T_1_D2_ Memo    ( T_1_A3_ Character  # T_1_B3_ Memo    & T_1_C3_ Numeric  # T_1_D3_ Memo    ( T_1_A4_ Character  # T_1_B4_ Memo    & T_1_C4_ Numeric  # T_1_D4_ Memo    ( T_1_A5_ Character  # T_1_B5_ Memo    & T_1_C5_ Numeric  # T_1_D5_ Memo    ( CUSNAME Character - # CUSDATE Date  ) ACCTNAME Character - $ ACCTDATE Date  " C_8 Logical   " C_9 Logical   # C_10 Logical   ( OFCNAME Character D # OFCDATE Date  # C_11 Logical   # C_12 Logical   # C_13 Logical   # C_14 Logical   # C_15 Logical   ( MGRSIGN Character D # MRGDATE Date  ) PROPSIGN Character D $ PROPDATE Date  ) WITNSIGN Character D $ WITNDATE Date  # PROPMRG Memo    # MGOFCDT Date  * FISCALOFC Character j $ FISCALDT Date  ?@d @}?O^$X 2 REPORT OF UNSERVICEABLE, LOST, STOLEN  2 DAMAGED OR DESTROYED PROPERTY ( !"#      P                       P  &&     ^$ d U.S. DEPARTMENT OF AGRICULTURE ( !"#                             P  &&&    W^( X q& PROPERTY REPORT NO.( Report!"-./5,6789:;>?@ABCG                         P #      $      ' #  Y@$.,! *  < && = &&     T^X q& DATE Date!"-./5B6789:;>?@ABCG                         P #      $      ' #  Y@$.,! *  < && = &&     2@HASVALUE (Date) and #UPDATONLY    Date  ~      7@datevalue (@datetext (Date, "%2-%1-%5"))   Date   %2-%1-%5  "  #  4@VALUE (@DATETEXT (Date,"%5"))<=29   Date   %5  "  x         o@SETVALUE (Date,@DATEVALUE (@CONCAT (@DATETEXT (Date,"%2-%1"),"-20",@DATETEXT (Date,"%5"))),TRUE)   Date   Date   %2-%1  "   -20   Date   %5  "      #       "$ qD SECTION I - ACCOUNTABLE PROPERTY OFFICER'S REPORT M !"#                             P  &&    f"$ }& 3. PROPERTY ITEMS (See attachment for additional entries)  M !"#                             P  &&     V~       P    ~$ q& 1. STATUS OF PROPERTY (Check only one-report each one type separately) ( !"#                             P  &&    ~ q& Unserviceable   C_1# $%&' ()+,-.                             P   !  * &  1   2      3      m@RESETOBJ (c_2);@RESETOBJ (c_3);@RESETOBJ (c_4);@RESETOBJ (c_5);@RESETOBJ (c_6);@RESETOBJ (c_7)   C_2       C_3       C_4       C_5       C_6       C_7    ~ q& Obsolete   C_2# $%&' ()+,-.                             P   !  * &  1   2      3      m@RESETOBJ (c_1);@RESETOBJ (c_3);@RESETOBJ (c_4);@RESETOBJ (c_5);@RESETOBJ (c_6);@RESETOBJ (c_7)   C_1       C_3       C_4       C_5       C_6       C_7    ~ q& Damaged   C_3# $%&' ()+,-.                             P   !  * &  1   2      3      m@RESETOBJ (c_2);@RESETOBJ (c_1);@RESETOBJ (c_4);@RESETOBJ (c_5);@RESETOBJ (c_6);@RESETOBJ (c_7)   C_2       C_1       C_4       C_5       C_6       C_7    . ~ q& Lost or Stolen   C_4#$%&' ()+,-.                             P   !  * &  1   2      3      m@RESETOBJ (c_2);@RESETOBJ (c_3);@RESETOBJ (c_1);@RESETOBJ (c_5);@RESETOBJ (c_6);@RESETOBJ (c_7)   C_2       C_3       C_1       C_5       C_6       C_7    .  q& Cannibalized for parts   C_5#$%&' ()+,-.                             P   !  * &  1   2      3      m@RESETOBJ (c_2);@RESETOBJ (c_3);@RESETOBJ (c_4);@RESETOBJ (c_1);@RESETOBJ (c_6);@RESETOBJ (c_7)   C_2       C_3       C_4       C_1       C_6       C_7    .  q& Destroyed   C_6#$%&'()+,-.                             P   !  * &  1   2      3      m@RESETOBJ (c_2);@RESETOBJ (c_3);@RESETOBJ (c_4);@RESETOBJ (c_5);@RESETOBJ (c_1);@RESETOBJ (c_7)   C_2       C_3       C_4       C_5       C_1       C_7    . l q& Others   C_7 #$%& '()+,-.                             P   !  * &  1   2      3      m@RESETOBJ (c_2);@RESETOBJ (c_3);@RESETOBJ (c_4);@RESETOBJ (c_5);@RESETOBJ (c_6);@RESETOBJ (c_1)   C_2       C_3       C_4       C_5       C_6       C_1    1 l.  StaProp! "-./56 789:;>?@ABCG                         P #      $      '   Y@$.,! *  < && = &&     ~ q& 2. REPORTING ACTIVITY (Show agency, unit and address) ,$ !"#                             P  &&    F RptAdr# $(),,-.$/012456789                                    P ! "y$%#&')*                    ;  Y@$.,!  ( &&  3 &&    A     A     A     A     ?#    /Adr1"$%#&')*                    ;  Y@$.,!  ( &&     /Adr2"$%#&')*                    ;  Y@$.,!  ( &&     /Adr3"$%#&')*                    ;  Y@$.,!  ( &&     /Adr4"$%#&')*                    ;  Y@$.,!  ( &&     . F q&U QUANTITY  q& (Or property no.)    !"#      _                       P  &&    .   q& ITEM DESCRIPTION AND OTHER DETAILS, INCLUDING  q& SERIAL NUMBERS AND ACQUISITION DATE  q&q (Give present condition and estimated cost of repair)   !"#      _                       P  &&    |. x q&f ACQUISITION COST ,   !"#                             P  &&    ^.   q&: EXPLANATION/DISPOSAL INSTRUCTIONS  q& (If lost, stolen, or destroyed, give detail.  q& Was this reported to proper authorities?) 8  !"#      _                       P  &&    i  q&% A   !"#                             P  &&    i   q&% B   !"#                             P  &&    i> ! q& C 1  !"#                             P  &&    i " q& D C !"#                             P  &&    " "$4T 1 T_1# $(8),-.M/ 012456789                                    P !  "z$%&')*                      Y@$.,!  ( &&  3 &&    A     A     A     A     A     ?F     ?     ?x     ?     *F"$$% &')*                      Y@$.,!  ( &&&    ??O* "%$%&')*                       Y@$.,!6  ( &&&    ,x"&$% &')*                       $.,!  ( &&&    * "'$%&')*                       Y@$.,!6  ( &&&    *F"($% &')*                      Y@$.,!  ( &&&    * ")$%&')*                       Y@$.,!6  ( &&     ,x"*$% &')*                       $.,!  ( &&     * "+$%&')*                       Y@$.,!6  ( &&     *F",$% &')*                      Y@$.,!  ( &&&    *  "-$%&')*                       Y@$.,!6  ( &&     ,x ".$% &')*                       $.,!  ( &&     *  "/$%&')*                       Y@$.,!6  ( &&     *F "0$% &')*                      Y@$.,!  ( &&&    *  "1$%&')*                       Y@$.,!6  ( &&     ,x"2$% &')*                       $.,!  ( &&     * "3$%&')*                       Y@$.,!6  ( &&     *F"4$% &')*                      Y@$.,!  ( &&&    * "5$%&')*                       Y@$.,!6  ( &&     ,x"6$% &')*                       $.,!  ( &&     * "7$%&')*                       Y@$.,!6  ( &&     "$9 q SECTION II - PROPERTY MANAGEMENT OFFICER'S REVIEW AND RECOMMENDATION M !"#                             P  &&    v"$: qZ DETERMINATION FOR LOST, STOLEN, DAMAGED, OR DESTROYED PROPERTY M !"#                             P  &&    >|; q& 1. After due consideration of all known facts and circumstances in this case, it is determined that: - !"#                             P  &&    ~"$= q$ SECTION III - AUTHORIZATION FOR CANNIBALIZATION, ABANDONMENT, OR DESTRUCTION OF UNSERVICEABLE PROPERTY %M !"#                             P  &&     q& a.   C_8#>$%&'()+,-.                             P   !  * &  1   2      3      .@RESETOBJ (c_9);@RESETOBJ (c_10)   C_9       C_10     B q& The loss, theft, damage or destruction did not result from employee negligence and any involved employees are hereby relieved of liability. E !"#                             P  &     d q& b.   C_9#C$%& '()+,-.                             P   !  * &  1   2      3      .@RESETOBJ (c_8);@RESETOBJ (c_10)   C_8       C_10    d D q& There appears to be gross negligence involved; therefore, the case returned to agency officials for appropriate action under the Debt Collection Act.  E !"#                             P  &     , q& c.   C_10#E$%&!'()+,-.                             P   !  * &  1   2      3      -@RESETOBJ (c_9);@RESETOBJ (c_8)   C_9       C_8    ,LF q& There appears to be negligence involved; therefore, the case is returned to agency personnel officials for consideration of disciplinary  q& action. !> !"#                             P  &     VT X q& 4. NAME IN PRINT AND SIGNATURE  q&  OF CUSTODIANT ^CusName! "-G./56789:;>?@ABCG                         P #      $      ' -  Y@$.,! *  < && = &&     K VX q& DATE CusDate!"-I./56789:;>?@ABCG                         P #      $      ' h  Y@$.,! *  < && = &&     5@HASVALUE (CusDate) and #UPDATONLY    CusDate  ~      :@datevalue (@datetext (CusDate, "%2-%1-%5"))   CusDate   %2-%1-%5  "  #  7@VALUE (@DATETEXT (CusDate,"%5"))<=29   CusDate   %5  "  x         x@SETVALUE (CusDate,@DATEVALUE (@CONCAT (@DATETEXT (CusDate,"%2-%1"),"-20",@DATETEXT (CusDate,"%5"))),TRUE)    CusDate   CusDate   %2-%1  "   -20   CusDate   %5  "      #       V" X q& 5. NAME IN PRINT AND SIGNATURE  q&  OF ACCOUNTABLE PROPERTY OFFICER" ^AcctName!"-J./5*6789:;>?@ABCG                         P #      $      ' -  Y@$.,! *  < && = &&     LVX q& DATE AcctDate!"-K./5B6789:;>?@ABCG                         P #      $      ' h  Y@$.,! *  < && = &&     6@HASVALUE (AcctDate) and #UPDATONLY    AcctDate  ~      ;@datevalue (@datetext (AcctDate, "%2-%1-%5"))   AcctDate   %2-%1-%5  "  #  8@VALUE (@DATETEXT (AcctDate,"%5"))<=29   AcctDate   %5  "  x         |@SETVALUE (AcctDate, @DATEVALUE (@CONCAT (@DATETEXT (AcctDate,"%2-%1"),"-20",@DATETEXT (AcctDate,"%5"))),TRUE) !  AcctDate   AcctDate   %2-%1  "   -20   AcctDate   %5  "      #       L q& 2. NAME IN PRINT AND SIGNATURE OF PROPERTY MANAGEMENT OFFICERL OfcName!"-L./56#7>89:>;>?@ABCG                         P #      $      ' D  Y@$.,! *  < && = &&     O q& 3. DATE OfcDate!"-M./5B6#789:;>?@ABCG                         P #      $      ' h  Y@$.,! *  < && = &&     5@HASVALUE (OfcDate) and #UPDATONLY    OfcDate  ~      :@datevalue (@datetext (OfcDate, "%2-%1-%5"))   OfcDate   %2-%1-%5  "  #  7@VALUE (@DATETEXT (OfcDate,"%5"))<=29   OfcDate   %5  "  x         x@SETVALUE (OfcDate,@DATEVALUE (@CONCAT (@DATETEXT (OfcDate,"%2-%1"),"-20",@DATETEXT (OfcDate,"%5"))),TRUE)    OfcDate   OfcDate   %2-%1  "   -20   OfcDate   %5  "      #       W"$^N q& 1. Unserviceable property listed above is hereby authorized for cannibalization, abandonment, or destruction in accordance with FPMR 101-45.9 based on any of the  q& following determinations as further explained in section I-3(D): 'M !"#                             P  &&     V4! P      P     V! R      P     VZ# S      P     V"$ T      P    hRl ,U q& a. ) !"#                             P  <&     ?r?LNLl V q& Property has no commercial value.  ) !"#                             P  &     hR4!,W q& b. * !"#                             P  <&     L4!^X q& Health, safety, or security considerations require immediate  q& abandonment or destruction.  * !"#      Z                       P  &     hR",Y q& c. , !"#                             P  <&     L"Z q& Costs of care and handling exceed expected small lot sales proceeds.  , !"#                             P  &     hR#,[ q& d. - !"#                             P  <&     LZ#\ q& Regulation or directive requires abandonment or destruction.  - !"#                             P  &     l  ?    K KC_11#]$%&)'()+,-.                             P   !  *  1  2      3     4! ?    K KC_12#^$%&*'()+,-.                             P   !  *  1  2      3     " ?    K KC_13#_$%&,'()+,-.                             P   !  *  1  2      3     Z# ?    K KC_14#`$%&-'()+,-.                             P   !  *  1  2      3     &"$a q SECTION IV - CERTIFICATION FOR COMPLETION OF CANNIBALIZATION, ABANDONMENT, OR DESTRUCTION: I certify that cannibalization,  q) abandonment, or destruction action for the items authorized under Section III was completed on this date in accordance with I-3(D). 1M !"#                             P  &&    qN%L q& 2. SIGNATURE OF PROPERTY MANAGEMENT OFFICERL MgrSign!"-b./56/7>89:>;>?@ABCG                         P #      $      ' D  Y@$.,! *  < && = &&     ON% q& 3. DATE MrgDate!"-c./5B6/789:;>?@ABCG                         P #      $      ' h  Y@$.,! *  < && = &&     5@HASVALUE (MrgDate) and #UPDATONLY    MrgDate  ~      :@datevalue (@datetext (MrgDate, "%2-%1-%5"))   MrgDate   %2-%1-%5  "  #  7@VALUE (@DATETEXT (MrgDate,"%5"))<=29   MrgDate   %5  "  x         x@SETVALUE (MrgDate,@DATEVALUE (@CONCAT (@DATETEXT (MrgDate,"%2-%1"),"-20",@DATETEXT (MrgDate,"%5"))),TRUE)    MrgDate   MrgDate   %2-%1  "   -20   MrgDate   %5  "      #       sn(L q& 1. SIGNATURE OF ACCOUNTABLE PROPERTY OFFICERL PropSign!"-d./5637>89:>;>?@ABCG                         P #      $      ' D  Y@$.,! *  < && = &&     Pn( q& 2. DATE PropDate!"-e./5B63789:;>?@ABCG                         P #      $      ' h  Y@$.,! *  < && = &&     6@HASVALUE (PropDate) and #UPDATONLY    PropDate  ~      ;@datevalue (@datetext (PropDate, "%2-%1-%5"))   PropDate   %2-%1-%5  "  #  8@VALUE (@DATETEXT (PropDate,"%5"))<=29   PropDate   %5  "  x         |@SETVALUE (PropDate, @DATEVALUE (@CONCAT (@DATETEXT (PropDate,"%2-%1"),"-20",@DATETEXT (PropDate,"%5"))),TRUE) !  PropDate   PropDate   %2-%1  "   -20   PropDate   %5  "      #       ^)L q& 3. SIGNATURE OF WITNESSL WitnSign!"-f./5657>89:>;>?@ABCG                         P #      $      ' D  Y@$.,! *  < && = &&     P) q& 4. DATE WitnDate! "-g./5B65789:;>?@ABCG                         P #      $      ' h  Y@$.,! *  < && = &&     6@HASVALUE (WitnDate) and #UPDATONLY    WitnDate  ~      ;@datevalue (@datetext (WitnDate, "%2-%1-%5"))   WitnDate   %2-%1-%5  "  #  8@VALUE (@DATETEXT (WitnDate,"%5"))<=29   WitnDate   %5  "  x         |@SETVALUE (WitnDate, @DATEVALUE (@CONCAT (@DATETEXT (WitnDate,"%2-%1"),"-20",@DATETEXT (WitnDate,"%5"))),TRUE) !  WitnDate   WitnDate   %2-%1  "   -20   WitnDate   %5  "      #       +"$h q< SECTION V - CERTIFICATIONS OF PROPERTY AND FISCAL OFFICERS 7M !"#                             P  &&    V,LX q& 1. SIGNATURE OF PROPERTY MANAGEMENT OFFICER (The necessary entries have been made to adjust property records.)L PropMrg!!"-i./5687>89:>;>?@ABCG                         P #    Z  $    Z  '  D  Y@$.,! *  < && = &&     OV,X q& 2. DATE MgOfcDt!""-j./5B68789:;>?@ABCG                         P #      $      ' h  Y@$.,! *  < && = &&     5@HASVALUE (MgOfcDt) and #UPDATONLY    MgOfcDt  ~      :@datevalue (@datetext (MgOfcDt, "%2-%1-%5"))   MgOfcDt   %2-%1-%5  "  #  7@VALUE (@DATETEXT (MgOfcDt,"%5"))<=29   MgOfcDt   %5  "  x         y@SETVALUE (MgOfcDt, @DATEVALUE (@CONCAT (@DATETEXT (MgOfcDt,"%2-%1"),"-20",@DATETEXT (MgOfcDt,"%5"))),TRUE)    MgOfcDt   MgOfcDt   %2-%1  "   -20   MgOfcDt   %5  "      #       p.^^k q& 3.  ; !"#                             P  &&    V.^m q& SIGNATURE OF FISCAL OFFICER [The necessary action has been taken to adjust the accounting records and, where required by a  q& determination made under Section II above, to effect collection from involved employee(s).] ;< !"#                             P  &&    P/L p FiscalOfc FiscalOfc!#"-n./56=7>89:;>?@ABCG                         P #      $      ' j  Y@$.,! *  < && = &&     P. q& 4. DATE FiscalDt!$"-o./5B6;789:;>?@ABCG                         P #      $      ' h  Y@$.,! *  < && = &&     6@HASVALUE (FiscalDt) and #UPDATONLY    FiscalDt  ~      ;@datevalue (@datetext (FiscalDt, "%2-%1-%5"))   FiscalDt   %2-%1-%5  "  #  8@VALUE (@DATETEXT (FiscalDt,"%5"))<=29   FiscalDt   %5  "  x         |@SETVALUE (FiscalDt, @DATEVALUE (@CONCAT (@DATETEXT (FiscalDt,"%2-%1"),"-20",@DATETEXT (FiscalDt,"%5"))),TRUE) !  FiscalDt   FiscalDt   %2-%1  "   -20   FiscalDt   %5  "      #       }j1p q AD FORM 112 (Rev. 3/94) ? !"#                             P  &&     j1q d This form was electronically produced by Elite Federal Forms, Inc. 1? !"#                             P  &&     V4! u      P    hl ,v q& e. ,) !"#                             P  <&     ? ? 6w q& Property is uneconomical to repair/not needed by another  q& user and may be cannibalized for parts. (Cannibalization is  q& a form of use and property management regulations shall apply.  q& Remainder of property must be disposed of through  q& usual procedures.) .)" !"#                             P  &     l  ?    K KC_15#x$%*&)'()+,-.                             P   !  *  1  2      3     ?=$defg =<$defg <^o elite10.DLL IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. elite10.COM IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. WPIN$ELITE10FunctionSet,4.1 ^=Z@z=VZa