ResCare, Inc.

Property, Plant and Equipment

Asset Disposal / Transfer Form

Instructions:
Fill in as many areas as apply to your transaction
Send approved form to the Fixed Asset Dept. at the Resource Center

Is this location being deactivated? Yes No

Name of ResCare Operation: Operation #:

Address where asset is located: Location #:

1. Asset Number: 2. Asset tag #

3. Asset Description: 4. Manufacturer:

5. Model 6. Serial #

For DISPOSAL / RETIREMENT

7. Reason for Disposal (circle one): Casualty Loss Broken Soiled Other

8. Method of Disposal (circle one): Sale Donation Trade-in Other

9. Removal Cost: 10. Proceeds of sale:

11. Disposals must be approved by: Executive Director: Date:

Regional Finance Director: Date:

To be filled out by Resource Center

Retirement Number:
Number of units retired:
Cost Retired:
NBV Retired:

For TRANSFER

12. Transfer Date:

13. Transfer From:

14. Transfer To:

15. Transfers must be approved by

Receiving Facility Executive Director Date:
or Regional Finance Director

Keyed by/date: _____________________