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New Capital Equipment Record Form   Department Information: Department: Dept. Code: * Preparer Information: Name: Phone: * NetID: * Equipment Information: Building Code: * Room Num.: Item Description: Bar Code/Tag Num State ID Manufacturer: * * Model Serial Num Acquisition Cost/Value * Acquisition Date Condition Code Purchase Order Num * * User Name Gift in Kind Gift Donor Num Yes No Available for Shared Use Service Facility Lease Yes No Yes No Yes No OSP Num Contract/Grant Num Lease Expiration Date Government ID Contractor ID Num Control Purposes Only Yes No (Use Limited to Contract Colleges) Source of Funding: Journal Number: * Department * Subledger * Object Code * Grant/Contract Amount * $ $ $ $ * Total Acquisition Cost: $

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