Home Use Authorization 08
Form # DPP-HUA-04-04 Approved 04-12-04 Revised 03-17-08 Comm. of Prop. Proc. PRINT IN TRIPLICATE Date: Other: To Be Returned: Government of the U.S. Virgin Islands HOME USE AUTHORIZATION Authorization No. *Condition Codes: Serial No. Name of User Justification for Home Use: Division Print Name/Title: User's Signature & Date: Annual Renewal Approved by (Sign & Date): Instructions for Initial Authorization: Complete and send original to the respective Agency Head's Office until the equipment is returned. The Departmental Accountable Officer should also retain a copy of this form. * Condition Code: Location Department/Agency/Bureau E - Excellent G - Good F - Fair P - Poor U - Unusable L - Lost S - Stolen X - Surplus Instructions for Return: Use retained original, complete bottom portion of form and return to the respective Agency Head's Office. The Departmental Accountable Officer should also retain a copy of this form. Complete Upon Return of Equipment The equipment listed above has been returned. …
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Form # DPP-HUA-04-04 Approved 04-12-04 Revised 03-17-08 Comm. of Prop. Proc. PRINT IN TRIPLICATE Date: Other: To Be Returned: Government of the U.S. Virgin Islands HOME USE AUTHORIZATION Authorization No. *Condition Codes: Serial No. Name of User Justification for Home Use: Division Print Name/Title: User's Signature & Date: Annual Renewal Approved by (Sign & Date): Instructions for Initial Authorization: Complete and send original to the respective Agency Head's Office until the equipment is returned. The Departmental Accountable Officer should also retain a copy of this form. * Condition Code: Location Department/Agency/Bureau E - Excellent G - Good F - Fair P - Poor U - Unusable L - Lost S - Stolen X - Surplus Instructions for Return: Use retained original, complete bottom portion of form and return to the respective Agency Head's Office. The Departmental Accountable Officer should also retain a copy of this form. Complete Upon Return of Equipment The equipment listed above has been returned. User's Signature & Date: Print Name/Title: Verified by (Sign & Date): Description of Equipment Work Phone No. Emergency Phone No. Asset ID No./*Condition Code