MISSING, DAMAGED OR STOLEN PROPERTY REPORT
NOTE: If property has been stolen or is lost, destoyed or damaged as a result of negligence, this form should
be completed and sent to the Office of the Attorney General within 72 hours.

Name of agency/institution Agency no.    
   
Place of Occurrence City County
Police agency notified Police report number Disposal code Estimated value at date of loss
Serial Number(s) Purchase Date Purchase Value  
 
 
 
 
       
State Property Number Component Number Description Location
Person(s) responsible for asset(s) Property Manager Name Property Manager Phone

Report in detail (including what security measures were in place at the time)

Our investigation of the circumstances surrounding the state
property listed herein indicates reasonable cause to believe that the loss,
destruction, or damage to this property was through the negligence
of the person(s) charged with the care and custody of this property

Our investigation of the circumstances surrounding the state
property listed herein indicates reasonable cause to believe that the loss,
destruction, or damage to this property was not through the negligence
of the person(s) charged with the care and custody of this property