Fill and Sign the Removal Form

Barcode Tag Number Description Serial Number (only if no barcode tag)                                                                                                                                                                                                      Transfer from: person/dept Removal from premises.             Disposal or other       Comments:                   Employee Name:       Signature:       Date:             Dept / IT Manager       Controller       For Accounting use: initials / date entered into system       Property returned: initials / date entered into system      -129Property / Fixed Asset Form Return Date:Instructions: Please check the appropriate box and explain the reason for the equipment/asset being moved in the comments section, the proper name/location for the property/asset to reside, and for how long. Proper authorization must be received from your manager or the vice president of your department. If this is just a transfer from one cube/location or department to another then the authorization is only needed from the managers of the related department/departments. For further instructions please refer to the Fixed Asset Policy in Claires' office or under cc:mail bulletin board - Forms or contact Thank you. Expiration Date: to: Applies only for removal of property from premises. Authorization to deduct property cost from wages: I hereby authorize the Company to deduct from any of my accrued wages and /or vacation pay an amount equal to the net book value of any property or equipment of the company that I fail to return to the company within ten (10) days of leaving the Company. Net book value as used herein shall mean the cost to the Company of the property or equipment minus the accumulated depreciation as of the date of employee's termination. Authorization: Dept Manager