MODEL NUMBER:	     
SERIAL NUMBER:	     
TRANSFERRING AGENCY	     
     
     
     
LOCATION CODE	     
ASSET CLASS	     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
MODEL NUMBER:	     
SERIAL NUMBER:	     
RECEIVING AGENCY	     
NEW LOCATION CODE	     
ASSET CLASS (if applicable)	     
NEW ASSET ID	     
PROFILE ID (Core-CT agencies only)	     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     

PROPERTY TRANSFER BETWEEN AGENCIES

CO-64 Rev. 2/2016

STATE OF CONNECTICUT
OFFICE OF THE STATE COMPTROLLER

USE THIS FORM TO FACILITATE ASSET COLLECTION BETWEEN STATE AGENCIES

Complete the following sections:

  1. TRANSFERRING AGENCY:
       a.  Transferring Agency Section
       b.  Description of Asset
       c.  Accounting Information
       d.  Signature Authorization
       e.  Send the CO-64 to the Receiving Agency
       f.   RETAIN COPY IN FILE

2. RECEIVING AGENCY:
     a.  Receiving Agency Section
     b.  Accounting Information
     c.  Signature Authorization
     d.  RETAIN COPY IN FILE

TRANSFERRING AGENCY:
To be completed by the Transferring Agency

DESCRIPTION OF ASSET

PDC Authorization Number

ASSET ID

PROFILE ID (Core-CT agencies only)

CHARTFIELD - COMPLETED BY TRANSFERRING AGENCY (CORE-CT AGENCIES ONLY)

HISTORICAL COST

FUND

DEPARTMENT

SID

PROGRAM

ACCOUNT

PROJECT/GRANT

CHARTFIELD 1

CHARTFIELD 2

BUDGET REF.

FOR NON CORE-CT AGENCIES, LIST YOUR ACCOUNT CODE STRING BELOW:

THE ABOVE DETAILED ASSET TRANSFER IS AUTHORIZED.  THIS ASSET IS TO BE REMOVED FROM THE AGENCY'S ASSET MANAGEMENT SYSTEM.

AUTHORIZED SIGNATURE

TITLE

TELEPHONE NO.

DATE

RECEIVING AGENCY:
To be completed by the Receiving Agency

DESCRIPTION OF ASSET

CHARTFIELD - COMPLETED BY RECEIVING AGENCY (CORE-CT AGENCIES ONLY)

HISTORICAL COST

FUND

DEPARTMENT

SID

PROGRAM

ACCOUNT

PROJECT/GRANT

CHARTFIELD 1

CHARTFIELD 2

BUDGET REF.

FOR NON CORE-CT AGENCIES, LIST YOUR ACCOUNT CODE STRING BELOW:

RECEIVING AGENCY ACCEPTANCE

THE ABOVE DETAILED ASSET TRANSFER IS AUTHORIZED.  THE ASSET IS TO BE ENTERED INTO THE AGENCY'S ASSET MANAGEMENT SYSTEM.

AUTHORIZED SIGNATURE

TITLE

TELEPHONE NO.

DATE