B08_Solicitation_Attach_3_DI-105_Property_Receipt_Hand_Receipt.pdf
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- Attached to
- Eastern States ORC Region 1
- Solicitation number
- 140L0126R0001
About this file
This is a Property Receipt (Hand Receipt) form (DI-105, 05/2025) issued by the U.S. Department of the Interior for documenting the transfer of government property to employees or authorized recipients. The form serves as an official record that establishes accountability for physical assets under the control of DOI bureaus and offices. Section 1 captures property information including the bureau/office cost center, item numbers, inventory numbers, detailed descriptions (make, model, manufacturer, serial numbers), quantities, units of issue, and acquisition costs across up to 20 line items, with an additional notes field for supplementary information.
Sections 2 and 3 establish the chain of custody through signatures and acknowledgment of responsibility. The issuing official (Section 2) provides their name, title, date issued, and signature, while the recipient (Section 3) acknowledges receipt by signing and dating the form. The recipient explicitly agrees to assume sole responsibility for the proper use, care, and safeguarding of issued property, with clear notice that they may be held financially liable for repair, replacement, or associated costs in cases of loss, theft, damage, or misuse due to negligence or non-compliance with DOI policy. Records are classified as short-term administrative temporary records with a retention period of three years after cut-off, governed under disposition authority DAA-0048-2013-0001-0001.
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Text version
DI-105 (05/2025)
U.S. Department of the Interior
PROPERTY RECEIPT (HAND RECEIPT)
Section 1: Property Information *required fields
1. Bureau/Office Cost Center:*
2. Item Number
3. Inventory Number
4. Description (make, model, manufacturer, serial number) 5. Qty 6. Unit of Issue
7. Acquisition
Cost
2a. 3a. 4a. 5a. 6a. 7a.
2b. 3b. 4b. 5b 6b. 7b.
2c. 3c. 4c. 5c. 6c. 7c.
2d. 3d. 4d. 5d. 6d. 7d.
2e. 3e. 4e. 5e. 6e. 7e.
2f. 3f. 4f. 5f. 6f. 7f.
2g. 3g. 4g. 5g. 6g. 7g.
2h. 3h. 4h. 5h. 6h. 7h.
2i. 3i. 4i. 5i. 6i. 7i.
2j. 3j. 4j. 5j. 6j. 7j.
2k. 3k. 4k. 5k. 6k. 7k.
2l. 3l. 4l. 5l. 6l. 7l.
2m. 3m. 4m. 5m. 6m. 7m.
2n. 3n. 4n. 5n. 6n. 7n.
2o. 3o. 4o. 5o. 6o. 7o.
2p. 3p. 4p. 5p. 6p. 7p.
2q. 3q. 4q. 5q. 6q. 7q.
2r. 3r. 4r. 5r. 6r. 7r.
2s. 3s. 4s. 5s. 6s. 7s.
2t. 3t. 4t. 5t. 6t. 7t.
8. Notes:
DI-105 (05/2025)
U.S. Department of the Interior
Records Disposition: DAA-0048-2013-0001-0001 – Short-Term Administrative Records Temporary. Cut-off record as instructed in the agency/bureau records manual, or at the end of the fiscal year in which the record is created if no unique cut-off is specified. Destroy 3 years after cut-off.
Section 2: Issued By Information *required fields
9. First Name:* 10. Middle Initial: 11. Last Name:*
12. Title:* 13. Date Issued:*
14. Signature:* 15: Date:*
Section 3: Received By Information *required fields
I understand and agree that I am solely responsible for the proper use, care, and safeguarding of the property issued to me. In the event of loss, theft, damage, or misuse due to negligence or failure to comply with DOI policy, I may be held financially liable for repair, replacement, or associated costs.
16. First Name:* 17. Middle Initial: 18. Last Name:*
19. Title:* 20. Signature:* 21. Date:*
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| 11 Last Name: |
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| 13 Date Issued: |
| 15 Date: |
| 16 First Name: |
| 18 Last Name: |
| 19 Title: |
| 21 Date: |
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