DEVELOPMENTAL DISABILITIES ADMINISTRATION NAME DATE Companion Home Client Inventory Record PURCHASE GUARDIAN RECORDING PRICE DESCRIPTION MODEL / SERIAL REASON FOR DATE DISPOSED BY: DATE NOTIFIED OF SIGNATURE (ITEMS $25 (COLOR, ETC.) NUMBER DISPOSAL DISPOSED SIGNATURE DISPOSAL* AND OVER) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
DEVELOPMENTAL DISABILITIES ADMINISTRATION Companion Home Client Inventory Record NAME DATE DATE RECORDING SIGNATURE PURCHASE PRICE (ITEMS $25 AND OVER) DESCRIPTION (COLOR, ETC.) MODEL / SERIAL NUMBER REASON FOR DISPOSAL DATE DISPOSED GUARDIAN NOTIFIED OF DISPOSAL* DISPOSED BY: SIGNATURE Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
17-259.docx