+--------------------------+--------------------+---------------------+
| ## REPORT                | 1.  HOLDING AGENCY | DATE RECEIVED (GSA  |
|  OF EXCESS REAL PROPERTY |     NO.            | use only)           |
+--------------------------+--------------------+---------------------+
|                          | 2.  DATE OF REPORT | GSA CONTROL NO.     |
|                          |                    | (GSA use only)      |
|                          |                    |                     |
+--------------------------+--------------------+---------------------+

+-----------------------------------+-----------------------------------+
| 3\. TO                            | 4\. FROM                          |
|                                   |                                   |
| (Furnish address of GSA regional  | (Name and address of holding      |
| offices)                          | agency)                           |
+-----------------------------------+-----------------------------------+
| 5\. NAME AND ADDRESS OF           | 6\. NAME AND ADDRESS OF CUSTODIAN |
| REPRESENTATIVE TO BE CONTACTED    |                                   |
+-----------------------------------+-----------------------------------+
| 7\. PROPERTY IDENTIFICATION       | 8\. PROPERTY ADDRESS *(Give full  |
|                                   | location)*                        |
+-----------------------------------+-----------------------------------+

  ----------------------------------------------------- -----------------
  **9. SPACE DATA**                                     **10. LAND**

  ----------------------------------------------------- -----------------

+----------+-------+------+--------+--------+--------+--------+--------+
| Use      | N     | F    | NUMBER | FLOOR  | CLEAR  | *(From | ACRE/H |
|          | umber | loor | OF     | LOAD   | HE     | SF     | ECTARE |
|          | of    | Area | FLOORS | CA     | ADROOM | 118B)* | OR SQ. |
|          | Buil  |      |        | PACITY |        |        | FT     |
|          | dings | *    |        |        |        |        | ./M^2^ |
|          |       | (sq. |        |        |        |        |        |
|          | \(1\) | ft   |        |        |        |        |        |
|          |       | ./M^ |        |        |        |        |        |
|          |       | 2^)* |        |        |        |        |        |
|          |       |      |        |        |        |        |        |
|          |       | \    |        |        |        |        |        |
|          |       | (2\) |        |        |        |        |        |
+----------+-------+------+--------+--------+--------+--------+--------+
| A.       |       |      |        |        |        | A. FEE |        |
| OFFICE   |       |      |        |        |        |        |        |
+----------+-------+------+--------+--------+--------+--------+--------+
| B.       |       |      |        |        |        | B.     |        |
| STORAGE  |       |      |        |        |        | LEASED |        |
+----------+-------+------+--------+--------+--------+--------+--------+
| C. OTHER |       |      |        |        |        | C.     |        |
|          |       |      |        |        |        | OTHER  |        |
| *(See    |       |      |        |        |        |        |        |
| 9F)*     |       |      |        |        |        |        |        |
+----------+-------+------+--------+--------+--------+--------+--------+
| D. TOTAL |       |      |        |        |        | D.     |        |
|          |       |      |        |        |        | TOTAL  |        |
| *(From   |       |      |        |        |        |        |        |
| SF 18A)* |       |      |        |        |        |        |        |
+----------+-------+------+--------+--------+--------+--------+--------+
| E. GOV'T |       |      | F.     |        |        |        |        |
| I        |       |      | S      |        |        |        |        |
| NTEREST: |       |      | PECIFY |        |        |        |        |
|          |       |      | "      |        |        |        |        |
| \(1\)    |       |      | OTHER" |        |        |        |        |
| OWNER    |       |      | USE    |        |        |        |        |
|          |       |      | E      |        |        |        |        |
|          |       |      | NTERED |        |        |        |        |
|          |       |      | IN C   |        |        |        |        |
|          |       |      | ABOVE  |        |        |        |        |
|          |       |      |        |        |        |        |        |
|          |       |      |        |        |        |        |        |
+----------+-------+------+--------+--------+--------+--------+--------+
| \(2\)    |       |      |        |        |        |        |        |
| TENANT   |       |      |        |        |        |        |        |
+----------+-------+------+--------+--------+--------+--------+--------+

  ----------------------------------- -----------------------------------
  **11. COST TO GOVERNMENT**          **12. LEASEHOLD(S) DATA *(Use
                                      separate sheet if necessary)***

  ----------------------------------- -----------------------------------

+---------------+-------+---------+----------------------+-----------+
| ITEM          | SCH   | COST    | A. TOTAL ANNUAL      | \$0.00    |
|               | EDULE |         | RENTAL               |           |
+---------------+-------+---------+----------------------+-----------+
| A. BUILDINGS, | A     | \$0.00  | B. ANNUAL RENT PER   | \$0.00    |
| STRUCTURES,   | (Col. |         | SQ. FT./,M^2^ OR     |           |
| UTILITIES,    | d)    |         | ACRE/HECTARE         |           |
| AND           |       |         |                      |           |
| MISCELLANEOUS |       |         |                      |           |
| FACILITIES    |       |         |                      |           |
+---------------+-------+---------+----------------------+-----------+
|               |       |         | C. DATE LEASE        |           |
|               |       |         | EXPIRES              |           |
+---------------+-------+---------+----------------------+-----------+
| B. LAND       | B     | \$0.00  | D. NOTICE REQUIRED   |           |
|               | (Col. |         | FOR RENEWAL          |           |
|               | f)    |         |                      |           |
+---------------+-------+---------+----------------------+-----------+
| C. RELATED    | C     | \$0.00  | E. TERMINAL DATE OF  |           |
| PERSONAL      | (Col. |         | RENEWAL RIGHTS       |           |
| PROPERTY      | h)    |         |                      |           |
+---------------+-------+---------+----------------------+-----------+
| D. TOTAL (Sum |       | \$0.00  | F. ANNUAL RENEWAL    | \$0.00    |
| of 11A, 11B,  |       |         | RENT PER SQ.         |           |
| and 11C)      |       |         | FT./M^2^ OR ACRE/HA. |           |
+---------------+-------+---------+----------------------+-----------+
| E. ANNUAL     |       |         | G. TERMINATION       |           |
| PROTECTION    |       |         | RIGHTS (in days)     |           |
| AND           |       |         |                      |           |
| MAINTENANCE   |       |         | LESSOR               |           |
| COST          |       |         | GOVERNMENT           |           |
| (Gov          |       |         |                      |           |
| ernment-owned |       |         |                      |           |
| or leased)    |       |         |                      |           |
|               |       |         |                      |           |
|               |       |         |                      |           |
+---------------+-------+---------+----------------------+-----------+

+--------+-------------------------+-----------------------------------+
| 13\.   |                         | 14\. TYPE OF CONSTRUCTION         |
| DISPO  |                         |                                   |
| SITION |                         |                                   |
| OF     |                         |                                   |
| PR     |                         |                                   |
| OCEEDS |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| 15\.   |                         | 16\. RANGE OF POSSIBLE USES       |
| H      |                         |                                   |
| OLDING |                         |                                   |
| AGENCY |                         |                                   |
| USE    |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| 17\.   |                         |                                   |
| NAMES  |                         |                                   |
| AND    |                         |                                   |
| ADD    |                         |                                   |
| RESSES |                         |                                   |
| OF     |                         |                                   |
| INTE   |                         |                                   |
| RESTED |                         |                                   |
| F      |                         |                                   |
| EDERAL |                         |                                   |
| AG     |                         |                                   |
| ENCIES |                         |                                   |
| AND    |                         |                                   |
| OTHER  |                         |                                   |
| INTE   |                         |                                   |
| RESTED |                         |                                   |
| P      |                         |                                   |
| ARTIES |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| 18\.   |                         |                                   |
| R      |                         |                                   |
| EMARKS |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| 19\.   | NAME                    | SIGNATURE                         |
| REPORT |                         |                                   |
|        |                         |                                   |
| AUTH   |                         |                                   |
| ORIZED |                         |                                   |
|        |                         |                                   |
| BY     |                         |                                   |
+--------+-------------------------+-----------------------------------+
|        | TITLE                   |                                   |
+--------+-------------------------+-----------------------------------+