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Sheet: Sheet1

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 |  |  | State of Oklahoma |  |  |  | Surplus Property Transfer
 |  |  | Office of Management and Enterprise Services
 |  |  | Division of Capital Assets Management
 |  |  | State Surplus
 | INSTRUCTIONS (THIS PROCESS MUST BE FOLLOWED !!!):
 | 1. | Upon completion of "FORM" and "LIST", save and send the file to: [EMAIL]
 | 2. | DCAM Staff will review the request and email this form back indicating a decision (Approved or Denied)
 | 3. | Agency MUST call State Surplus at (405) 525-2354 for disposal / delivery of all property approved for surplus
 | 4. | Items will be verified against the approved form by the DCAM warehouse personnel at time of delivery
 | 5. | Any proceeds received by DCAM for disposal of property will be handled in accordance with 74 O.S. § 62.5
 |  | Agency:
 |  | Div./Dept.:
 |  | Authorized Officer:
 |  | Phone #: |  |  | City/County:
 |  | Date: |  | E-mail:
 |  | REQUIRED: By checking this box you certify that you are registered with OMES-Central Purchasing Division and                       are authorized to surplus items for your agency
 | Agencies may not dispose of surplus property without prior approval of DCAM.  It is the responsibility of the surplusing agency to (1) delete these items from its inventory and notify DCAM Risk Management, if applicable, for deletion from insurance coverage and (2) maintain surplus records in accordance with 74 O.S.§ 62.1 et. seq.
 | A. The property listed on the following page(s) is surplus to the needs of this agency for the following reason(s)      (MUST check all that apply):
 |  | No longer needed to perform the duties of the agency |  |  |  |  |  |  |  | 1 | False
 |  | Vehicle exceeded 60,000 miles or 24 months |  |  |  |  |  |  |  |  | DCAM Surplus Administrator
 |  | [NAME] and cost to repair is not economical
 |  | Obsolete and not compatible with newer equipment
 |  | Other (Explain):
 | [NAME] is requested for the following disposition of this surplus property      (MUST indicate recommended disposition):
 |  | Sell at public auction
 |  | Sell for scrap metal
 |  | Transfer to:
 |  | Trade-in
 |  | Disposal by DCAM Surplus Property with no remuneration to this agency.
 |  | Disposal by other means, which are deemed to be in the best interest of the state - Explain below:
 | *** APPROVAL AREA RESTRICTED ONLY FOR DCAM STAFF ***
 | CERTIFICATION |  | Approved | Denied | Date
 | DCAM Fleet Manager |  |  |  |  |  |  | SURPLUSED VEHICLES:
 | - |  |  |  |  |  | Value: | 0
 | DCAM Surplus Administrator |  |  |  |  |  | Volume: | 0
 | Comments:
 |  | City Government (specify below under "Div./Dept" and/or "City/County")
 |  | County Government(specify below under "Div./Dept" and/or "City/County")
 |  | School District (specify below under "Div./Dept" and/or "City/County")
 |  | [NAME], Oklahoma (1337)
 |  | Abstractors Board, Oklahoma (22)
 |  | Accountancy Board, Oklahoma (20)
 |  | Aeronautics Commission, Oklahoma (60)
 |  | Agriculture, Food and Forestry, Oklahoma Department of (40)
 |  | Alcohol and Drug Counselors, Oklahoma State Board of Licensed (448)
 |  | Alcoholic Beverage Laws Enforcement (30)
 |  | Anatomical Board, State (44)
 |  | Architects, Landscape Architects and Interior Designers, Oklahoma Board of Governors of the Licensed (45)
 |  | Ardmore Higher Education Center (606)
 |  | Arts Council, Oklahoma (55)
 |  | Attorney General (49)
 |  | Auditor and Inspector (300)
 |  | Banking Department, State (65)
 |  | Biological Survey, Oklahoma
 |  | Board of Tests for Alcohol and Drug Influence (772)
 |  | Boll Weevil Eradication Organization, Oklahoma (39)
 |  | Bond Advisor, Oklahoma State (582)
 |  | Building Bonds Commission (91)
 |  | Bureau of Investigation, Oklahoma State of (OSBI) (308)
 |  | Cameron University (100)
 |  | Capital Investment Board, Oklahoma (915)
 |  | Capitol Complex and Centennial Commemoration Commission (7)
 |  | Capitol Improvement Authority (105)
 |  | Capitol-Medical Center Improvement and Zoning Commission (120)
 |  | Career and Technology Education, Department of (800)
 |  | [NAME] (108)
 |  | Center for Advancement of Science & Technology (628)
 |  | Children & Youth, Oklahoma Commission on (127)
 |  | Chiropractic Examiners, State Board of (145)
 |  | Climatological Survey, Oklahoma
 |  | Commerce, Department of (160)
 |  | CompSource Oklahoma (390)
 |  | Connors State College (165)
 |  | Conservation Commission, Oklahoma (645)
 |  | Construction Industries Board (170)
 |  | Consumer Credit, Department of (635)
 |  | Corporation Commission, Oklahoma (185)
 |  | Corrections, Department of (131)
 |  | Cosmetology Board (190)
 |  | Criminal Appeals, Court of (199)
 |  | Dentistry, Board of (215)
 |  | Development Finance Authority, Oklahoma (900)
 |  | Disability Concerns, Office of (326)
 |  | District Attorneys Council (220)
 |  | District Courts (219)
 |  | East Central University (230)
 |  | Eastern Oklahoma State College (240)
 |  | Education, State Department of (265)
 |  | Educational Television Authority, Oklahoma (266)
 |  | Election Board, State (270)
 |  | Emergency Management, Oklahoma Department of (309)
 |  | Employees Benefits Council (815)
 |  | Employment Security Commission (290)
 |  | Energy Resources Board, Oklahoma (359)
 |  | Entrepreneurial Ex-Offenders Training & Support Program (131)
 |  | Environmental Finance Authority (920)
 |  | Environmental Quality, Department of (292)
 |  | Ethics Commission (296)
 |  | Fire Marshal, State (310)
 |  | Firefighters Pension and Retirement Syst. (315)
 |  | Foresters, State Board of Registration for (615)
 |  | Funeral Board, Oklahoma (285)
 |  | Geological Survey, Oklahoma (325)
 |  | Governor (305)
 |  | Grand River Dam Authority (980)
 |  | Health Care Authority, Oklahoma (807)
 |  | Health Sciences Center, OU Prof. Prac. Plan (771)
 |  | Health, Department of (340)
 |  | Historical Society, Oklahoma (350)
 |  | Homeland Security, Office of
 |  | Horse Racing Commission (353)
 |  | House of Representatives (422)
 |  | Housing Finance Agency, Oklahoma (922)
 |  | Human Rights Commission, Oklahoma (355)
 |  | Human Services, Department of (830)
 |  | Indian Affairs Commission, Oklahoma (360)
 |  | Indigent Defense System (47)
 |  | Industrial Finance Authority, Oklahoma (370)
 |  | Insurance Department, Oklahoma State (385)
 |  | Interstate Oil Compact Commission (307)
 |  | J.D. [NAME] (670)
 |  | [NAME] (204)
 |  | Judicial Complaints, Council on (678)
 |  | Juvenile Affairs, Office of (400)
 |  | LP Gas Research, Marketing and Safety Commission (444)
 |  | Labor, Department (405)
 |  | Land Office, Commissioners of the (410)
 |  | Langston University (420)
 |  | Law Enforcement Education and Training, Council on (415)
 |  | Law Enforcement Retirement System, Oklahoma (416)
 |  | Legislative Service Bureau (423)
 |  | Libraries, Department of (430)
 |  | Lieutenant Governor (440)
 |  | Liquefied Petroleum Gas Board (445)
 |  | Long Term Care Administrators, Oklahoma State Board of Examiners for (509)
 |  | Lottery Commission, Oklahoma (435)
 |  | Management and Enterprise Services, Office of (090)
 |  | Marginal Well Commission, Oklahoma (446)
 |  | Medical Licensure and Supervision, Board of (450)
 |  | Medicolegal Investigations, Board of (342)
 |  | Mental Health and Substance Abuse, Department of (452)
 |  | Merit Protection Commission, Oklahoma (298)
 |  | Military Department, Oklahoma (25)
 |  | Mines, Department of (125)
 |  | Motor Vehicle Commission, Oklahoma (475)
 |  | Multiple Injury Trust Fund (391)
 |  | Municipal Power Authority, Oklahoma (981)
 |  | Murray State College (470)
 |  | Narcotics and Dangerous Drugs Control, Bureau of (477)
 |  | Native American Cultural and Education Authority of Oklahoma (361)
 |  | Northeastern Oklahoma A & M College (480)
 |  | Northeastern State University (485)
 |  | Northern Oklahoma College (490)
 |  | Northwestern Oklahoma St. University (505)
 |  | Nursing, Oklahoma Board of (510)
 |  | OSU - Experiment Station (11)
 |  | OSU - Extension Division (12)
 |  | OSU - Technical Branch, Oklahoma City (15)
 |  | OSU - Technical Branch, [NAME] (13)
 |  | Oklahoma City Community College (633)
 |  | Oklahoma State University (OSU) (10)
 |  | Optometry Board (520)
 |  | Osteopathic Examiners, State Board of (525)
 |  | Osteopathic Medicine, College - OSU (773)
 |  | Panhandle State University (530)
 |  | Pardon and Parole Board (306)
 |  | Peanut Commission, Oklahoma (535)
 |  | Perfusionists, Board of Examiners of (343)
 |  | Pharmacy Board, State (560)
 |  | Physician Manpower Training Commission (619)
 |  | Podiatric Medical Examiners, State Board of (140)
 |  | Police Pension and Retirement System (557)
 |  | Private [NAME], Board of (563)
 |  | Professional Engineers & Land Surveyors, State Board of Licensure for (570)
 |  | Psychologists Examiners, Board of (575)
 |  | Public Employees Relations Board (585)
 |  | Public Employees Retirement System, Oklahoma (515)
 |  | Public Safety, Department of (585)
 |  | Quartz Mountain Arts and Conference Center and Nature Park (620)
 |  | Real Estate Commission, Oklahoma (588)
 |  | Redlands Community College (241)
 |  | Regents for A&M Colleges (600)
 |  | Regents for Higher Education (605)
 |  | Regional University System of Oklahoma (610)
 |  | Rehabilitation Services, Department of (805)
 |  | Rogers State University (461)
 |  | Rose State College (531)
 |  | Scenic Rivers Commission (568)
 |  | School of Science & Mathematics, Oklahoma (629)
 |  | Secretary of State (625)
 |  | Securities Commission, Oklahoma (630)
 |  | Seminole State College (623)
 |  | Senate, Oklahoma State (421)
 |  | Sheep and Wool Commission, Oklahoma (631)
 |  | Social Workers, Registration Board for Licensed (622)
 |  | Sorghum Commission, Oklahoma (38)
 |  | Southeastern Oklahoma St. University (660)
 |  | Southwestern Oklahoma State University (665)
 |  | Space Industry Development Authority (346)
 |  | Speech-Language Pathology and Audiology Board (632)
 |  | State & Education Employees Group Insurance Board (516)
 |  | Student Loan Authority, Oklahoma (618)
 |  | Supreme Court (677)
 |  | Tax Commission, Oklahoma (695)
 |  | Teacher Preparation, Oklahoma Commission for (269)
 |  | Teachers Retirement System (715)
 |  | Tobacco Settlement Endowment Trust (92)
 |  | Tourism & Recreation Department, Oklahoma (566)
 |  | Transportation, Department of (345)
 |  | [NAME], Oklahoma State (740)
 |  | Tulsa Community College (750)
 |  | Turnpike Authority, Oklahoma (978)
 |  | University Center at Tulsa (774)
 |  | University Hospitals Authority and Trust (825)
 |  | University of Central Oklahoma (120)
 |  | University of Oklahoma (760)
 |  | University of Oklahoma Health Sciences Center (770)
 |  | University of Oklahoma Law Center (761)
 |  | University of Science & Arts of Oklahoma (150)
 |  | Used Motor Vehicle and Parts Commission (755)
 |  | Veterans Affairs, Oklahoma Department of (650)
 |  | Veterinary Medical Examiners, Board of (790)
 |  | Veterinary Medicine, OSU College of (14)
 |  | Water Resources Board (835)
 |  | Western Oklahoma State College (41)
 |  | Wheat Commission (875)
 |  | Wildlife Conservation (320)
 |  | [NAME] (880)
 |  | Workers Compensation Court (369)
 |  | OTHER (specify below under "Div../Dept")