CTMD Form 4-5 "Report of Unaccounted Property" - Connecticut

What Is CTMD Form 4-5?

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 March 1, 2016;
  • 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 4-5 by clicking the link below or browse more documents and templates provided by the Connecticut Military Department.

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Download CTMD Form 4-5 "Report of Unaccounted Property" - Connecticut

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CTMD Form 4-5
(Rev. 3/2016)
CONNECTICUT MILITARY DEPARTMENT
REPORT OF UNACCOUNTED PROPERTY
PURPOSE: To provide details surrounding any circumstance in which state owned property is
unaccountable.
AUTHORITY: Connecticut General Statutes Section 4-33a, 4-36 and the State of Connecticut Property
Control Manual – Chapter 5 & Chapter 7.
INSTRUCTIONS: Property that has been deemed unaccounted must be reported by the hand
receipt holder’s to their immediate supervisor within 24 hours of when the item(s) were first noticed to
be missing. The immediate supervisor must make every effort to investigate the circumstances
surrounding the missing item(s) and report their findings to the Fiscal Administrative Manager within
48 hours of receiving the initial report.
• REPORT OF HAND RECEIPT HOLDER: Provide as much detail known about the item as
possible.
o What is the brand and model?
o How many are missing?
o What site was the item secured and where at that site? (ie: Name of Armory, building,
room number)
o When did you notice the item missing and who did you last see it with?
o What actions did you take to locate the item?
o Describe the security measures in place. (ie: locks, gates, cameras, etc.)
o Including the hand receipt holder, who else has access to the item that is unaccounted?
o If there were witnesses, provide their name and contact information for further
investigation.
• SUPERVISOR SUMMARY OF EVENTS: Provide as much detail as possible surrounding the
circumstances of the incident. Witnesses should provide additional information on a separate
statement.
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 4-5
(Rev. 3/2016)
CONNECTICUT MILITARY DEPARTMENT
REPORT OF UNACCOUNTED PROPERTY
PURPOSE: To provide details surrounding any circumstance in which state owned property is
unaccountable.
AUTHORITY: Connecticut General Statutes Section 4-33a, 4-36 and the State of Connecticut Property
Control Manual – Chapter 5 & Chapter 7.
INSTRUCTIONS: Property that has been deemed unaccounted must be reported by the hand
receipt holder’s to their immediate supervisor within 24 hours of when the item(s) were first noticed to
be missing. The immediate supervisor must make every effort to investigate the circumstances
surrounding the missing item(s) and report their findings to the Fiscal Administrative Manager within
48 hours of receiving the initial report.
• REPORT OF HAND RECEIPT HOLDER: Provide as much detail known about the item as
possible.
o What is the brand and model?
o How many are missing?
o What site was the item secured and where at that site? (ie: Name of Armory, building,
room number)
o When did you notice the item missing and who did you last see it with?
o What actions did you take to locate the item?
o Describe the security measures in place. (ie: locks, gates, cameras, etc.)
o Including the hand receipt holder, who else has access to the item that is unaccounted?
o If there were witnesses, provide their name and contact information for further
investigation.
• SUPERVISOR SUMMARY OF EVENTS: Provide as much detail as possible surrounding the
circumstances of the incident. Witnesses should provide additional information on a separate
statement.
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
RESET FORM
CTMD Form 4-5
(Rev 3/2016)
CONNECTICUT MILITARY DEPARTMENT
REPORT OF UNACCOUNTED PROPERTY
REPORT OF HAND RECEIPT HOLDER
Item:
Brand:
Model:
Quantity:
Site:
Location stored on site:
Date & Time item noticed to be missing:
Person last seen with item:
Summary of actions taken to locate item:
What security measures were in place to secure the item?
Who had access to the area?
Were there any witnesses? If yes, list their names & contact information.
Printed Name:
Signature:
Date:
SUPERVISOR SUMMARY OF EVENTS
Summary of Events
Printed Name:
Signature:
Date:
TO BE COMPLETED BY FISCAL ADMINISTRATIVE MANAGER: (or designee)
CORE-CT Information
Item Name
Serial Number
Tag Number
Value
Printed Name:
Signature:
Date:
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