CTMD Form 4-12 "Authorization to Transfer State Property" - Connecticut

What Is CTMD Form 4-12?

This is a legal form that was released by the Connecticut Military Department - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2017;
  • The latest edition provided by the Connecticut Military Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CTMD Form 4-12 by clicking the link below or browse more documents and templates provided by the Connecticut Military Department.

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Download CTMD Form 4-12 "Authorization to Transfer State Property" - Connecticut

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CTMD Form 4-12
(Rev. 2/2017)
CONNECTICUT MILITARY DEPARTMENT
AUTHORIZATION TO TRANSFER STATE PROPERTY
(ASSET MANAGEMENT)
PURPOSE: Use of this form is to obtain approval for the transfer and/or disposition of state personal
property inventory items.
AUTHORITY: State of Connecticut Property Control Manual Chapter 5-10.
INSTRUCTIONS: Property that needs to be transferred with the agency will be recorded on this form
and retained by the Fiscal Administrative Manager or designee.
The requesting individual is responsible for completing this form to the fullest extent possible.
REQUESTOR INFORMATION: Provide the current location of the item(s) to be transferred and the
destination. Provide the appropriate account numbers for each location.
DESCRIPTION OF ITEMS: List the number of like items to be transferred, a description of the item,
the serial number, state CORE-CT tag number and the purpose of the transfer.
CERTIFICATION:
Releaser: Current property account holder
Receiver: Individual who will be the new property account
holder
SEND THIS FORM & SUPPORTING DOCUMENTATION TO:
Connecticut Military Department
State Property Officer
360 Broad Street Room #223
Hartford, Connecticut, 06105-3706
(860) 548-3247 (fax)
Page 1 of 2
CTMD Form 4-12
(Rev. 2/2017)
CONNECTICUT MILITARY DEPARTMENT
AUTHORIZATION TO TRANSFER STATE PROPERTY
(ASSET MANAGEMENT)
PURPOSE: Use of this form is to obtain approval for the transfer and/or disposition of state personal
property inventory items.
AUTHORITY: State of Connecticut Property Control Manual Chapter 5-10.
INSTRUCTIONS: Property that needs to be transferred with the agency will be recorded on this form
and retained by the Fiscal Administrative Manager or designee.
The requesting individual is responsible for completing this form to the fullest extent possible.
REQUESTOR INFORMATION: Provide the current location of the item(s) to be transferred and the
destination. Provide the appropriate account numbers for each location.
DESCRIPTION OF ITEMS: List the number of like items to be transferred, a description of the item,
the serial number, state CORE-CT tag number and the purpose of the transfer.
CERTIFICATION:
Releaser: Current property account holder
Receiver: Individual who will be the new property account
holder
SEND THIS FORM & SUPPORTING DOCUMENTATION TO:
Connecticut Military Department
State Property Officer
360 Broad Street Room #223
Hartford, Connecticut, 06105-3706
(860) 548-3247 (fax)
Page 1 of 2
CTMD Form 4-12
(Rev. 2/2017)
CONNECTICUT MILITARY DEPARTMENT
AUTHORIZATION TO TRANSFER STATE PROPERTY
(ASSET MANAGEMENT)
CONTROL NUMBER:
REQUESTOR INFORMATION
Requestor:
Date:
February 10, 2017
From:
To:
Location:
Location:
Account #:
Account #:
DESCRIPTION OF ITEMS
Quantity
Equipment Description
Serial Number
State Tag#
Reason for Request
CERTIFICATION:
Releaser:
Printed Name
Signature
Date
Receiver:
Printed Name
Signature
Date
Page 2 of 2
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