B08_Solicitation_Attach_3_DI-105_Property_Receipt_Hand_Receipt.pdf

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Attached to
Eastern States ORC Region 6
Solicitation number
140L0126R0006
Issued by

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This is a Property Receipt (Hand Receipt) form (DI-105) used by the U.S. Department of the Interior to document the transfer of property to individual employees or contractors. The form serves as an official record of accountability and includes up to 20 line items for tracking equipment, supplies, or other assets issued.

Section 1 captures property information including the Bureau/Office Cost Center, Item Number, Inventory Number, detailed Description (make, model, manufacturer, serial number), Quantity, Unit of Issue, and Acquisition Cost for each item. Section 2 requires the issuing official's information (First Name, Middle Initial, Last Name, Title, Date Issued, and Signature with date). Section 3 documents the receiving party's information (First Name, Middle Initial, Last Name, Title, Signature, and Date) and includes a statement of accountability in which the recipient acknowledges sole responsibility for proper use, care, and safeguarding of issued property, with notification of potential financial liability for loss, theft, damage, or misuse due to negligence or failure to comply with DOI policy. The form is classified as Short-Term Administrative Records (temporary) with a three-year retention period after cut-off, governed by Records Disposition DAA-0048-2013-0001-0001.

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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:*

1 BureauOffice Cost Center:
3a:
4a:
5a:
6a:
7a:
4b:
5b:
6b:
7b:
4c:
5c:
6c:
7c:
3d:
4d:
5d:
6d:
7d:
3e:
4e:
5e:
6e:
7e:
3f:
4f:
5f:
6f:
7f:
3g:
4g:
5g:
6g:
7g:
3h:
4h:
5h:
6h:
7h:
3i:
4i:
5i:
6i:
7i:
3j:
4j:
5j:
6j:
7j:
3k:
4k:
5k:
6k:
7k:
3l:
4l:
5l:
6l:
7l:
3m:
4m:
5m:
6m:
7m:
3n:
4n:
5n:
6n:
7n:
3o:
4o:
5o:
6o:
7o:
3p:
4p:
5p:
6p:
7p:
3q:
4q:
5q:
6q:
7q:
3r:
4r:
5r:
6r:
7r:
3s:
4s:
5s:
6s:
7s:
3t:
4t:
5t:
6t:
7t:
8 Notes:
11 Last Name:
12 Title:
13 Date Issued:
15 Date:
16 First Name:
18 Last Name:
19 Title:
21 Date:
9 First Name:
10 Middle Initial:
17 Middle Initial:
3c:
3b:

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