


SURPLUS PROPERTY NOMINATION FORM
CITY OF ANYTOWN, TENNESSEE
DEPARTMENT: __________________________________
The following items are hereby nominated for designation as surplus city property pursuant to
City Resolution No. __________________:
Item: _______________________________________________________________________
Description: __________________________________________________________________
Serial Number: _______________________________________________________________
Age: ___________ Asset #___________ Estimated remaining useful life (years)__________
Purchase price: Estimated Current Value:
Reasons for making the nomination: ______________________________________________
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Signature Date