B08_Solicitation_Attach_3_DI-105_Property_Receipt_Hand_Receipt.pdf

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Attached to
Eastern States ORC Region 4
Solicitation number
140L0126R0004
Issued by

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This is a Property Receipt (Hand Receipt) form (DI-105) issued by the U.S. Department of the Interior for documenting the transfer of property to employees or personnel. The form serves as an official record that establishes accountability for government property and transfers responsibility for safeguarding assets from the issuing authority to the receiving individual.

Section 1 captures property details across up to twenty items, requiring the Bureau/Office Cost Center, Item Number, Inventory Number, detailed Description (including make, model, manufacturer, and serial number), Quantity, Unit of Issue, and Acquisition Cost for each asset. Section 2 documents issuance information, requiring the issuer's name, title, signature, and date of issuance. Section 3 requires the recipient's name, title, and signature, along with the date received. The form includes a critical liability statement in Section 3 where the recipient acknowledges sole responsibility for proper use, care, and safeguarding of the property, and agrees that they may be held financially liable for any loss, theft, damage, or misuse due to negligence or failure to comply with Department of Interior policy. Records are classified as Short-Term Administrative Records and must be cut off and destroyed three years after the cut-off date, per Records Disposition authority 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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