KEEP THIS DOCUMENT IN A SAFE PLACE

Instructions:

  1. Fill out this form and print a copy from your browser for your copy.
  2. Click on the "Submit" button at the bottom of this page to send it to the Department of Public Safety.
  3. Records will only be kept for 4 years.

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Residence Hall Address:
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Item
Make and Model
Serial Number
Value
COMPUTER
CALCULATOR
CD PLAYER
GAME SYSTEM
CAMERA
TELEPHONE
ANSWERING MACHINE
STEREO
JEWELRY
MUSICAL INSTRUMENT
POWER TOOLS
RADIO
TELEVISION
BICYCLE
SPEAKERS
APPLIANCES
OTHER #1
OTHER #2
OTHER #3