FIXED ASSET ADD FORM - SAU 9

School Administrative Unit No. 9176A Main StreetNorth Conway, NH 03818FIXED ASSET ADD FORMDate: ____________School District: ___________Fiscal Year of Purchase _________________Building ____________________TO BE COMPLETED BY SCHOOLRequisition Number ______________ Asset Description ____________________________** Quantity _________ ** Number of Asset Tags Needed __________(If multiple tags required, complete reverse side)Acquired Value (per item) ___________Vendor _______________________________________________Model # ______________________________________________Budget Account # _________________________________Completed by: _________________________ Date: ___________Donated: Yes ___ No ___ Donated by _______________________TO BE COMPLETED BY SCHOOL AFTER RECEIPT OF FIXED ASSET TAGSerial # _____________________________________________________(If multiple, see reverse side)Room/Area _____________Floor __________________Completed by: _____________________________ Date: ______________TO BE COMPLETED BY SAU OFFICEPurchase Order Number ______________Asset # _____________ Federal Asset Tag # ______________ (if required)Federal Project/Grant #/Name ____________________________________Completed by: ____________________________Date: ___________

MULTIPLE FIXED ASSET TAGSAsset Tag # Description Serial # Model # Room/Area